Systematic review and meta-analysis links prenatal NSAIDs to higher kidney disease risk in children
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Key Takeaway
Consider that prenatal NSAIDs use is associated with increased kidney disease risk in children.
This systematic review and meta-analysis examined the relationship between prenatal NSAIDs exposure and kidney disease risk in children. The analysis included a sample size of 4,159,617 individuals. The primary outcome assessed was kidney disease risk. The study did not report adverse events or serious adverse events. The authors did not report tolerability or discontinuations. The review did not report a specific setting or follow-up duration.
Key findings indicate an adjusted odds ratio of 2.40 (95% CI 1.84–3.13) for kidney disease risk associated with prenatal NSAIDs use. Unadjusted analysis showed an odds ratio of 1.10 (95% CI 1.05–1.15). Overall risk yielded an odds ratio of 1.36 (95% CI 1.14–1.62). Risk was also increased in the second trimester with an odds ratio of 1.17 (95% CI 1.09–1.26) and in the third trimester with an odds ratio of 1.10 (95% CI 1.09–1.11).
The authors acknowledge that the data do not solve causality issues concerning potential confounding by other risk factors. They state that more high-quality studies are needed to establish whether the association with NSAIDs is causal. The review did not report practice relevance or funding conflicts. Clinicians should interpret these findings cautiously given the limitations regarding confounding.
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View Original Abstract ↓
ObjectiveStudies have shown a link between prenatal NSAIDs exposure and childhood kidney disease; however, consensus is lacking. Therefore, we conducted a meta-analysis to assess maternal prenatal exposure to NSAIDs and its relationship with the kidney disease risk in children.MethodsA systematic search of PubMed, Cochrane Library, Embase, and Web of Science was performed, supplemented by a manual search of references, to identify relevant observational studies for our analysis. Data extraction and quality assessment were independently conducted by two investigators. A random effects meta-analysis was conducted to estimate the summary odds ratio (ORs) and the corresponding 95% confidence interval (CIs).ResultsSeven studies including 4,159,617 participants were selected. The analysis indicated that there was an association between prenatal NSAIDs exposure and kidney disease risk in children (OR 1.36 [1.14–1.62]). After adjusted (OR 2.40 [1.84–3.13]) and unadjusted (OR 1.10 [1.05–1.15]) analyses, the use of NSAIDs during pregnancy was associated with the kidney disease risk in children. Use of NSAIDs in the second and third trimesters of pregnancy is associated with the kidney disease risk in children (second-trimester OR 1.17 [1.09–1.26] and third-trimester OR 1.10 [1.09–1.11]). Sensitivity analysis supported these findings.ConclusionWith our meta-analysis, we provide evidence for an association between prenatal NSAIDs exposure and kidney diseases in children but do not solve the causality issues concerning potential confounding by other risk factors. More high-quality studies are needed to establish whether the association with NSAIDs is causal.
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