mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2020-3-132-139mrj-1042Research ArticleОБЗОРЫREVIEWSПроблемы назначения нестероидных противовоспалительных препаратов женщинам репродуктивного возраста с анкилозирующим спондилитомProblems of prescribing nonsteroidal anti-inflammatory drugs for reproductive-aged women with ankylosing spondylitisКричевскаяО. А.KrichevskayaO. A.

Ольга Аркадьевна Кричевская

115522, Москва, Каширское шоссе, 34А

Olga Arkadievna Krichevskaya

34A, Kashirskoe Shosse, Moscow 115522

o.krichevskaya@mail.ruДубининаТ. В.DubininaT. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

КаратеевА. Е.KarateevA. E.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202021092020143132139Copyright © Кричевская О.А., Дубинина Т.В., Каратеев А.Е., 20202020Кричевская О.А., Дубинина Т.В., Каратеев А.Е.Krichevskaya O.A., Dubinina T.V., Karateev A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/1042

Нестероидные противовоспалительные препараты (НПВП) являются препаратами первого ряда в терапии анкилозирующего спондилита (АС), их действие связано с блокадой фермента циклооксигеназы 2 и опосредованным снижением синтеза простагландинов (ПГ). Однако ПГ играют важную роль в регулировании функций женской репродуктивной системы. В статье представлены современные данные об участии ПГ в фолликулогенезе, овуляции, имплантации и развитии эмбриона, родовой деятельности. На основании данных экспериментальных и клинических исследований обсуждается возможность НПВП за счет ингибирования синтеза ПГ вызывать нарушения овуляции, в том числе синдром лютеинизации неовулировавшего фолликула и спонтанные аборты. Обоснованно проведение дальнейших исследований с целью определения наиболее оптимальных схем терапии НПВП при планировании беременности и во время гестации у женщин с АС.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line medications for ankylosing spondylitis (AS); their action is associated with blockade of the enzyme cyclooxygenase 2 and with a mediated decrease in the synthesis of prostaglandins (PGs). However, PGs play an important role in regulating the functions of the female reproductive system. The paper presents an update on the participation of PG in folliculogenesis, ovulation, implantation, and development of the embryo, and labor activity. Based on experimental and clinical findings, the authors discuss whether due to inhibition of the synthesis of PGs, NSAIDs are able to cause ovulation failure, including luteinized unovulated follicle syndrome and spontaneous abortions. Further investigation is justified to determine the most optimal NSAID therapy regimens when planning pregnancy and during gestation in women with AS.

анкилозирующий спондилитнестероидные противовоспалительные препаратысиндром лютеинизации неовулировавшего фолликулабеременностьankylosing spondylitisnonsteroidal anti-inflammatory drugsluteinized unovulated follicle syndromepregnancyReferencesRudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009 Jun;68(6):777-83. doi: 10.1136/ard.2009.108233. Epub 2009 Mar 17.Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009 Jun;68(6):777-83. doi: 10.1136/ard.2009.108233. Epub 2009 Mar 17.Rudwaleit M, van der Heijde D, Landewe R, et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011 Jan;70(1):25-31. doi: 10.1136/ard.2010.133645. Epub 2010 Nov 24.Rudwaleit M, van der Heijde D, Landewe R, et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011 Jan;70(1):25-31. doi: 10.1136/ard.2010.133645. Epub 2010 Nov 24.Rudwaleit M, Haibel H, Baraliakos X, et al. The early disease stage in axial spondylarthritis: Results from the german spondyloarthritis inception cohort. Arthritis Rheum. 2009 Mar;60(3):717-27. doi: 10.1002/art.24483.Rudwaleit M, Haibel H, Baraliakos X, et al. The early disease stage in axial spondylarthritis: Results from the german spondyloarthritis inception cohort. Arthritis Rheum. 2009 Mar;60(3):717-27. doi: 10.1002/art.24483.Kiltz U, Baraliakos X, Karakostas P, et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken). 2012 Sep;64(9):1415-22. doi: 10.1002/acr.21688.Kiltz U, Baraliakos X, Karakostas P, et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken). 2012 Sep;64(9):1415-22. doi: 10.1002/acr.21688.Sieper J, van der Heijde D. Review: Nonradiographic axial spondyloarthritis: New definition of an old disease? Arthritis Rheum. 2013 Mar;65(3):543-51. doi: 10.1002/art.37803.Sieper J, van der Heijde D. Review: Nonradiographic axial spondyloarthritis: New definition of an old disease? Arthritis Rheum. 2013 Mar;65(3):543-51. doi: 10.1002/art.37803.Каратеев АЕ, Насонов ЕЛ, Ивашкин ВТ и др. Рациональное использование нестероидных противовоспалительных препаратов. Клинические рекомендации. Научно-практическая ревматология. 2018; 56(Прил. 1):1-29. doi: 10.14412/1995-44842018-1-29Karateev AE, Nasonov EL, Ivashkin VT, et al. Rational use of nonsteroidal antiinflammatory drugs. Clinical guidelines. Klinicheskie rekomendatsii. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2018;56(S1):1-29. (In Russ.). doi: 10.14412/1995-44842018-1-29Шостак НА, Клименко АА. Нестероидные противовоспалительные препараты современные аспекты их применения. Клиницист. 2013;7(3-4):53-61.Shostak NA, Klimenko AA. Non-steroidal anti-inflammatory drugs – modern aspects of their use. Klinitsist. 2013;7(3-4):53-61. (In Russ.).Ricciotti E, Fitzgerald GA. Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol. 2011 May;31(5):986-1000. doi: 10.1161/ATVBAHA.110.207449.Ricciotti E, Fitzgerald GA. Prostaglandins and inflammation. Arterioscler Thromb Vasc Biol. 2011 May;31(5):986-1000. doi: 10.1161/ATVBAHA.110.207449.Langenbach R, Loftin C, Lee C, Tiano H. Cyclooxygenase knockout mice-Models for elucidating isoform-specific functions. Biochem Pharmacol. 1999 Oct 15;58(8):1237-46. doi: 10.1016/s0006-2952(99)00158-6.Langenbach R, Loftin C, Lee C, Tiano H. Cyclooxygenase knockout mice-Models for elucidating isoform-specific functions. Biochem Pharmacol. 1999 Oct 15;58(8):1237-46. doi: 10.1016/s0006-2952(99)00158-6.Niringiymukiza JD, Cai H, Xiang W. Prostaglandin E 2 involvement in mammalian female fertility: ovulation, fertilization, embryo development and early implantation. Reprod Biol Endocrinol. 2018 May 1;16(1):43. doi: 10.1186/s12958-018-0359-5.Niringiymukiza JD, Cai H, Xiang W. Prostaglandin E 2 involvement in mammalian female fertility: ovulation, fertilization, embryo development and early implantation. Reprod Biol Endocrinol. 2018 May 1;16(1):43. doi: 10.1186/s12958-018-0359-5.Каратеев АЕ, Насонов ЕЛ. Применение нестероидных противовоспалительных препаратов при ревматических заболеваниях. В кн.: Насонов ЕЛ, редактор. Российские клинические рекомендации. Ревматология. Москва: ГЭОТАР-Медиа; 2017. С. 339-59.Karateev AE, Nasonov EL. Use of nonsteroidal anti-inflammatory drugs in rheumatic diseases. In: Nasonov EL, editor. Rossiiskie klinicheskie rekomendatsii. Revmatologiya [Russian clinical guidelines. Rheumatology. Moscow: GEOTAR-Media; 2017. P. 339-59].Каратеев АЕ. Обладают ли нестероидные противовоспалительные препараты патогенетическим действием? Современная ревматология. 2012;6(4):13-22. doi: 10.14412/1996-7012-2012-758Karateev AE. Have nonsteroidal antiinflammatory drugs a pathogenetic action? Sovremennaya revmatologiya = Modern Rheumatology Journal. 2012;6(4):13-22. (In Russ.). doi: 10.14412/1996-7012-2012-758Wanders A, van der Heijde D, Landewe R, et al. Nonsteroidal anti-inflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: A randomized clinical trial. Arthritis Rheum. 2005 Jun;52(6): 1756-65. doi: 10.1002/art.21054.Wanders A, van der Heijde D, Landewe R, et al. Nonsteroidal anti-inflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: A randomized clinical trial. Arthritis Rheum. 2005 Jun;52(6): 1756-65. doi: 10.1002/art.21054.Haroon N. Ankylosis in ankylosing spondylitis: current cocepts. Clin Rheumatol. 2015 Jun;34(6):1003-7. doi: 10.1007/s10067015-2956-4.Haroon N. Ankylosis in ankylosing spondylitis: current cocepts. Clin Rheumatol. 2015 Jun;34(6):1003-7. doi: 10.1007/s10067015-2956-4.Milanez FM, Saad VT, Moraes JC, et al. IL-23/Th17 axis is not influenced by TNFblocking agents in ankylosing spondylitis patients. Arthritis Res Ther. 2016 Feb 24;18:52. doi: 10.1186/s13075-016-0949-6.Milanez FM, Saad VT, Moraes JC, et al. IL-23/Th17 axis is not influenced by TNFblocking agents in ankylosing spondylitis patients. Arthritis Res Ther. 2016 Feb 24;18:52. doi: 10.1186/s13075-016-0949-6.Zhang JR, Pang DD, Dai SM. Nonsteroidal anti-inflammatory drugs are unlikely to inhibit radiographic progression of ankylosing spondylitis: a systematic review. Front Med (Lausanne). 2019 Oct 4;6:214. doi: 10.3389/fmed.2019.00214. eCollection 2019.Zhang JR, Pang DD, Dai SM. Nonsteroidal anti-inflammatory drugs are unlikely to inhibit radiographic progression of ankylosing spondylitis: a systematic review. Front Med (Lausanne). 2019 Oct 4;6:214. doi: 10.3389/fmed.2019.00214. eCollection 2019.Кричевская ОА, Гандалоева ЗМ, Дубинина ТВ. Анкилозирующий спондилит и беременность: современный взгляд на проблему. Современная ревматология. 2018;12(3):19–28. doi: 10.14412/1996-7012-20183-19-28Krichevskaya OA, Gandaloeva ZM, Dubinina TV. Ankylosing spondylitis and pregnancy: a current view on the problem. Sovremennaya revmatologiya = Modern Rheumatology Journal. 2018;12(3):19–28. (In Russ.). doi: 10.14412/1996-7012-20183-19-28Gotestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. doi: 10.1136/annrheumdis-2015-208840. Epub 2016 Feb 17.Gotestam Skorpen C, Hoeltzenbein M, Tincani A, et al. The EULAR points to consider for use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Ann Rheum Dis. 2016 May;75(5):795-810. doi: 10.1136/annrheumdis-2015-208840. Epub 2016 Feb 17.Кошелева НМ. Планирование беременности и наблюдение за беременными с ревматическими заболеваниями. В кн.: Насонов ЕЛ, редактор. Российские клинические рекомендации. Ревматология. Москва: ГЭОТАР-Медиа; 2017. С. 380-9.Kosheleva NM. Pregnancy planning and monitoring of pregnant women with rheumatic diseases. In: Nasonov EL, editor. Rossiiskie klinicheskie rekomendatsii. Revmatologiya [Russian clinical guidelines. Rheumatology]. Moscow: GEOTAR-Media; 2017. P. 380-9.U.S. Food and Drug Administration, Lactation, and Reproductive Potential: Labeling for Human Prescription Drug and Biological Products – Content and Format, Guidance for Industry; https://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm425398.pdfU.S. Food and Drug Administration, Lactation, and Reproductive Potential: Labeling for Human Prescription Drug and Biological Products – Content and Format, Guidance for Industry; https://www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm425398.pdfВласова ГА, Перминова СГ, Кошелева НМ и др. Репродуктивная функция у женщин с иммуновоспалительными ревматическими заболеваниями. Акушерство и гинекология. 2019;(10):51-9.Vlasova GA, Perminova SG, Kosheleva NM, et al. Reproductive function in women with immuno-inflammatory rheumatic diseases. Akusherstvo i ginekologiya. 2019;(10):51-9. (In Russ.).Боярский КЮ, Кахиани ЕИ. Молекулярные процессы фолликулогенеза. От овуляции до формирования желтого тела (обзор литературы). Проблемы репродукции. 2018;24(2):9-22.Boyarskii KYu, Kakhiani EI. Molecular processes of folliculogenesis. From ovulation to the formation of the yellow body (literature review). Problemy reproduktsii. 2018;24(2): 9-22. (In Russ.).Сафронова НА, Калинина ЕА, Донников АЕ и др. Перспективы исследования маркеров клеток кумулюса для оценки качества ооцитов и эмбрионов в программах вспомогательных репродуктивных технологий. Акушерство и гинекология. 2015; (12):21-5.Safronova NA, Kalinina EA, Donnikov AE, et al. Prospects for the study of Cumulus cell markers for assessing the quality of oocytes and embryos in assisted reproductive technology programs. Akusherstvo i ginekologiya. 2015;(12):21-5. (In Russ.).Kimura N, Konno Y, Miyoshi K, et al. Expression of Hyaluronan Synthases and CD44 Messenger RNAs in Porcine CumulusOocyte Complexes During In Vitro Maturation1. Biol Reprod. 2002 Mar;66(3): 707-17. doi: 10.1095/biolreprod66.3.707.Kimura N, Konno Y, Miyoshi K, et al. Expression of Hyaluronan Synthases and CD44 Messenger RNAs in Porcine CumulusOocyte Complexes During In Vitro Maturation1. Biol Reprod. 2002 Mar;66(3): 707-17. doi: 10.1095/biolreprod66.3.707.Ochsner SA, Russell DL, Day AJ, et al. Decreased expression of tumor necrosis factor-alpha-stimulated gene 6 in cumulus cells of the cyclooxygenase-2 and EP 2 null mice. Endocrinology. 2003 Mar;144(3):1008-19. doi: 10.1210/en.2002-220435.Ochsner SA, Russell DL, Day AJ, et al. Decreased expression of tumor necrosis factor-alpha-stimulated gene 6 in cumulus cells of the cyclooxygenase-2 and EP 2 null mice. Endocrinology. 2003 Mar;144(3):1008-19. doi: 10.1210/en.2002-220435.Давыдов АИ, Стрижаков АН. Нейрогуморальная регуляция менструального цикла. Гинекология. Курс лекций. Москва: ГЭОТАР-Медиа; 2009.Davydov AI, Strizhakov AN. Neirogumoral'naya regulyatsiya menstrual'nogo tsikla. Ginekologiya. Kurs lektsii [Neurohumoral regulation of the menstrual cycle. Gynecology. Course of lectures]. Moscow: GEOTAR-Media; 2009.Кибанов МВ, Махмудова ГМ, Гохберг ЯА. Поиск идеального маркера для оценки рецептивности эндометрия: от гистологии до молекулярно-генетических подходов. Альманах клинической медицины. 2019;47(1):12–25.Kibanov MV, Makhmudova GM, Gokhberg YaA. Search for the ideal marker for evaluating endometrial receptivity: from histology to molecular genetic approaches. Al'manakh klinicheskoi meditsiny. 2019;47(1): 12–25. (In Russ.).Song H, Lim H, Paria BC, et al. Cytosolic phospholipase A2alpha is crucial [correction of A2al- pha deficiency is crucial] for 'on-time' embryo implantation that directs subsequent development. Development. 2002 Jun;129(12):2879-89.Song H, Lim H, Paria BC, et al. Cytosolic phospholipase A2alpha is crucial [correction of A2al- pha deficiency is crucial] for 'on-time' embryo implantation that directs subsequent development. Development. 2002 Jun;129(12):2879-89.Vilella F, Ramirez L, Berlanga O, et al. PGE2 and PGF2α concentrations in human endometrial fluid as biomarkers for embryonic implantation. J Clin Endocrinol Metab. 2013 Oct;98(10):4123-32. doi: 10.1210/jc.2013-2205. Epub 2013 Aug 26.Vilella F, Ramirez L, Berlanga O, et al. PGE2 and PGF2α concentrations in human endometrial fluid as biomarkers for embryonic implantation. J Clin Endocrinol Metab. 2013 Oct;98(10):4123-32. doi: 10.1210/jc.2013-2205. Epub 2013 Aug 26.Перфилова ВН, Михайлова ЛИ, Тюренков ИН. Роль эндотелиальных биологически активных веществ в прогнозировании развития и оценке степени тяжести преэклампсии. Акушерство и гинекология. 2013;(11):24-9.Perfilova VN, Mikhailova LI, Tyurenkov IN. The role of endothelial biologically active substances in predicting the development and severity of preeclampsia. Akusherstvo i ginekologiya. 2013;(11):24-9. (In Russ.).Gaytan F, Morales C, Bellido C, et al. Non-steroidal anri-inflammatory drugs (NSAID) and ovulation: lesson from morphology. Histol Histopathol. 2006 May;21(5): 541-56. doi: 10.14670/HH-21.541.Gaytan F, Morales C, Bellido C, et al. Non-steroidal anri-inflammatory drugs (NSAID) and ovulation: lesson from morphology. Histol Histopathol. 2006 May;21(5): 541-56. doi: 10.14670/HH-21.541.Gaytan F, Tarradas E, Bellido C, et al. Prostaglandin E1 inhibits abnormal follicle rupture and restores ovulation in indomethacin-treated rats. Biol Reprod. 2002 Oct;67(4): 1140-7. doi: 10.1095/biolreprod67.4.1140.Gaytan F, Tarradas E, Bellido C, et al. Prostaglandin E1 inhibits abnormal follicle rupture and restores ovulation in indomethacin-treated rats. Biol Reprod. 2002 Oct;67(4): 1140-7. doi: 10.1095/biolreprod67.4.1140.Killick S, Elstein M. Pharmacologic production of luteinized unruptured follicles by prostaglandin synthetase inhibitors. Fertil Steril. 1987 May;47(5):773-7. doi: 10.1016/s0015-0282(16)59163-8Killick S, Elstein M. Pharmacologic production of luteinized unruptured follicles by prostaglandin synthetase inhibitors. Fertil Steril. 1987 May;47(5):773-7. doi: 10.1016/s0015-0282(16)59163-8Micu MC, Micu R, Ostensen M. Luteinized unruptured follicle syndrome increased by inactive disease and selective cyclooxygenase 2 inhibitors in women with inflammatory arthropathies. Arthritis Care Res (Hoboken). 2011 Sep;63(9):1334-8. doi: 10.1002/acr.20510.Micu MC, Micu R, Ostensen M. Luteinized unruptured follicle syndrome increased by inactive disease and selective cyclooxygenase 2 inhibitors in women with inflammatory arthropathies. Arthritis Care Res (Hoboken). 2011 Sep;63(9):1334-8. doi: 10.1002/acr.20510.Akil M, Amos RS, Stewart P. Infertility may sometimes be associated with NSAID consumption. Br J Rheumatol. 1996 Jan; 35(1):76-8. doi: 10.1093/rheumatology/35.1.76.Akil M, Amos RS, Stewart P. Infertility may sometimes be associated with NSAID consumption. Br J Rheumatol. 1996 Jan; 35(1):76-8. doi: 10.1093/rheumatology/35.1.76.Jesam C, Salvatierra AM, Schwartz JL, et al. Suppression of follicular rupture with meloxicam, a cyclooxygenase-2 inhibitor: potential for emergency contraception. Hum Reprod. 2010 Feb;25(2):368-73. doi: 10.1093/humrep/dep392. Epub 2009 Nov 19.Jesam C, Salvatierra AM, Schwartz JL, et al. Suppression of follicular rupture with meloxicam, a cyclooxygenase-2 inhibitor: potential for emergency contraception. Hum Reprod. 2010 Feb;25(2):368-73. doi: 10.1093/humrep/dep392. Epub 2009 Nov 19.Jesam C, Salvatierra AM, Schwartz JL, et al. Effect of oral administration of a continuous 18 day regimen of meloxicam on ovulation: experience of a randomized controlled trial. Contraception. 2014 Aug;90(2):168-73. doi: 10.1016/j.contraception.2014.04.011. Epub 2014 May 5.Jesam C, Salvatierra AM, Schwartz JL, et al. Effect of oral administration of a continuous 18 day regimen of meloxicam on ovulation: experience of a randomized controlled trial. Contraception. 2014 Aug;90(2):168-73. doi: 10.1016/j.contraception.2014.04.011. Epub 2014 May 5.Sherif BQ, Al-Zohyri AM, Shihab SS. Effect of some nonsteroidal anti-inflammatory drugs on ovulation in women with mild musculoskeletal pain (a clinical study). IOSR Journal of Pharmacy and Biological Sciences. 2014;9(4):43-49. doi: 10.9790/300809444349Sherif BQ, Al-Zohyri AM, Shihab SS. Effect of some nonsteroidal anti-inflammatory drugs on ovulation in women with mild musculoskeletal pain (a clinical study). IOSR Journal of Pharmacy and Biological Sciences. 2014;9(4):43-49. doi: 10.9790/300809444349Tomioka RB, Ferreira GRV, Aikawa NE, et al. Non-steroidal anti-inflammatory drug induces luteinized unruptured follicle syndrome in young female juvenile idiopathic arthritis patients. Clin Rheumatol. 2018 Oct; 37(10):2869-2873. doi: 10.1007/s10067-0184208-x. Epub 2018 Jul 12.Tomioka RB, Ferreira GRV, Aikawa NE, et al. Non-steroidal anti-inflammatory drug induces luteinized unruptured follicle syndrome in young female juvenile idiopathic arthritis patients. Clin Rheumatol. 2018 Oct; 37(10):2869-2873. doi: 10.1007/s10067-0184208-x. Epub 2018 Jul 12.Kailasam C, Hunt LP, Ryder I, et al. Safety and effectiveness of diclofenac sodium in assisted reproduction treatment: a randomized prospective double-blind study. Reprod Biomed Online. 2008 May;16(5):724-9. doi: 10.1016/s1472-6483(10)60488-9.Kailasam C, Hunt LP, Ryder I, et al. Safety and effectiveness of diclofenac sodium in assisted reproduction treatment: a randomized prospective double-blind study. Reprod Biomed Online. 2008 May;16(5):724-9. doi: 10.1016/s1472-6483(10)60488-9.Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003 Aug 16; 327 (7411):368. doi: 10.1136/bmj.327.7411.368Li DK, Liu L, Odouli R. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: population based cohort study. BMJ. 2003 Aug 16; 327 (7411):368. doi: 10.1136/bmj.327.7411.368Nielsen GL, Sorensen HT, Larsen H, et al. Risk of adverse birth outcome and miscarriage in pregnant users of non-steroial anti-inflammatory drugs: population based obser-vational study and case-control study. BMJ. 2001 Feb 3;322(7281):266-70. doi: 10.1136/bmj.322.7281.266Nielsen GL, Sorensen HT, Larsen H, et al. Risk of adverse birth outcome and miscarriage in pregnant users of non-steroial anti-inflammatory drugs: population based obser-vational study and case-control study. BMJ. 2001 Feb 3;322(7281):266-70. doi: 10.1136/bmj.322.7281.266Nakhai-Pour HR, Broy P, Sheehy O, et al. Use of nonaspirin nonsteroidal antiinflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ. 2011 Oct 18;183(15):1713-20. doi: 10.1503/cmaj.110454Nakhai-Pour HR, Broy P, Sheehy O, et al. Use of nonaspirin nonsteroidal antiinflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ. 2011 Oct 18;183(15):1713-20. doi: 10.1503/cmaj.110454Кошелева НМ, Насонов ЕЛ. Лекарственная терапия больных ревматическими заболеваниями при беременности и лактации. Научно-практическая ревматология. 2011;49(4):47-63. doi: 10.14412/1995-4484-2011-62Kosheleva NM, Nasonov EL. Drug therapy in patients with rheumatic diseases during pregnancy and lactation. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2011;49(4):47-63. (In Russ.). doi: 10.14412/1995-4484-2011-62

The authors declare that there are no conflicts of interest present.