ANTI-INFLAMMATORIES: RISKS AND BENEFITS FOR MATERNAL-FETAL HEALTH

Abstract

Introduction: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids (GCs) during pregnancy generates debate regarding maternal-fetal safety, requiring an analysis of potential therapeutic benefits versus risks of complications in fetal development. Objective: To conduct a literature review to critically and comprehensively analyze the use of anti-inflammatory drugs during pregnancy, highlighting the therapeutic benefits and risks to the health of both the mother and the fetus. Methodology: This is a systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2020) guidelines. Inclusion criteria were original articles that directly address the topic, fully available between 2015 and 2025, including population-based cohort studies, randomized clinical trials, and observational studies. Exclusion criteria were duplicate studies, case reports, letters to the editor, editorials, articles requiring paid access, conference abstracts, reviews, theses, dissertations, and publications that, after being read in their entirety, did not meet the objectives of this review. Controlled and uncontrolled search terms extracted from the DeCS and MeSH vocabularies—such as Pregnancy, Glucocorticoids, and Non-Steroidal Anti-Inflammatory Drugs—were combined using the Boolean operators “AND” and “OR” in both Portuguese and English and searched in the PubMed, VHL, SciELO, and Cochrane databases in April and May 2025. Results: Fourteen scientific articles were selected, showing that the use of NSAIDs may be associated with adverse cardiovascular and renal effects in newborns, especially when administered during the second and third trimesters. On the other hand, NSAID exposure has demonstrated benefits in promoting lung maturation and reducing neonatal respiratory morbidity; however, there is evidence of potential impacts on neurodevelopment in specific contexts. Regarding the maternal effects of NSAID use during pregnancy, available studies remain limited and inconclusive. Conclusion: Although NSAIDs and GCs offer relevant benefits—such as relief of maternal symptoms and stimulation of fetal lung maturation in high-risk situations—their use requires caution due to potential adverse effects (premature closure of the ductus arteriosus, neonatal hypertension, and neuropsychiatric risks). Their use should be guided by strict clinical criteria, obstetric monitoring, and dose adjustments according to gestational age. Final Considerations: This study highlights the complexity of anti-inflammatory use during pregnancy. It emphasizes the importance of a multidisciplinary approach to ensure that therapeutic decisions are based on robust scientific evidence and tailored to the individual needs of each pregnant woman.