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Is it safe for pregnant women to take painkillers?

We ask the experts to settle common questions we've all wondered about.

THE QUESTION: Is it safe for pregnant women to take common painkillers, such as acetylsalicylic acid, or ASA (Aspirin), acetaminophen (Tylenol) and ibuprofen (Advil)? A recent study suggested there may be an increased risk of certain reproductive problems in males whose mothers had used these drugs during pregnancy.

THE ANSWER: The simple truth is that pregnancy doesn't endow women with immunity against all the viruses and bacteria they may come in contact with over the nine months. Most women will get sick at some point while carrying a child and will need to take a prescription or over-the-counter medication such as ASA, acetaminophen or ibuprofen. Generally speaking, these common painkillers are safe to use, but it is always a good idea to consult your doctor or obstetrician before taking any medication.

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The study published in Human Reproduction in early November found an association with the use of common painkillers by pregnant women in Denmark and Finland and a higher risk of giving birth to sons with undescended testicles or cryptorchidism. There are still many questions that need to be addressed, including identifying the mechanism that causes the condition, before we can say with confidence these medications are the cause.

Also, the prevalence of cryptorchidism in Finland was much lower at only 2.4 per cent of all boys born in that country, compared to Denmark at 9.3 per cent, so environmental concerns need to be investigated. The incidence of cryptorchidism in Canada is closer to that of Finland at 3 per cent.

It should be noted that there are times during a pregnancy when a mild painkiller may be prescribed with no adverse outcomes. For example ASA in small doses for women who have had recurrent pregnancy loss can help them carry a child to full term. Acetaminophen and ibuprofen can be used effectively to manage pain for women with uterine fibroids.

Also, I need to point out there has also not been a conclusive link drawn between cryptorchidism and male fertility issues. In fact, most of the men we see in our clinic who are not producing sperm or have low sperm motility do not have a history of this condition. Just as significantly, not all men who had undescended testicles at birth will go on to have fertility problems.

My advice is any woman who is concerned about taking medication during a pregnancy should consult her physician or obstetrician. She should also check out Motherisk, a resource program of the Hospital for Sick Children in Toronto, which can be found on the Web at www.motherisk.org.

Dr. Heather Shapiro is a fertility specialist at the Mount Sinai Hospital Centre for Fertility and Reproductive Health in Toronto.

If you have a health question, send it to seriously@globeandmail.com.

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