Review Article | Published:

Analgesic use — prevalence, biomonitoring and endocrine and reproductive effects

Nature Reviews Endocrinology volume 12, pages 381393 (2016) | Download Citation

Abstract

Paracetamol and NSAIDs, in particular acetylsalicylic acid (aspirin) and ibuprofen, are among the most used and environmentally released pharmaceutical drugs. The differences in international trends in the sale and consumption of mild analgesics reflect differences in marketing, governmental policies, habits, accessibility, disease patterns and the age distribution of each population. Biomonitoring indicates ubiquitous and high human exposure to paracetamol and to salicylic acid, which is the main metabolite of acetylsalicylic acid. Furthermore, evidence suggests that analgesics can have endocrine disruptive properties capable of altering animal and human reproductive function from fetal life to adulthood in both sexes. Medical and public awareness about these health concerns should be increased, particularly among pregnant women.

Key points

  • Mild analgesics (hereafter, analgesics) consisting of paracetamol and NSAIDs are among the most used pharmaceutical drugs worldwide as well as the most released into the environment

  • Epidemiological data indicate a connection between maternal intake of analgesics and congenital reproductive abnormalities

  • Analgesics can have endocrine-disruptive actions in animals and humans of both sexes, from fetal life to adulthood

  • Medical and public awareness (especially that of pregnant women) must be increased about the potential hazards of analgesic use

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Acknowledgements

The authors' research is funded by The Danish Council for Independent Research (Medical Sciences) [D.M.K.], the Fondation pour la Recherche Médicale [P.G.], Inserm (Institut national de la santé et de la recherche médicale) [B.J., S.M.-G.], Rennes 1 University [L.L.], EHESP–School of Public Health [B.J., T.S.] and ANSM (Agence Nationale de la Sécurité du Médicament; grants N° AAP-2012-037 and N° HAP-2014-073) [B.J.]. We also thank T. Renberg from the Swedish Health Agency and T. Partio from the Finnish social security institution KELA for providing us with pharmaceutical sales data.

Author information

Affiliations

  1. Genomic and Molecular Biomedicine, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, DK-2200 Copenhagen N, Denmark.

    • David M. Kristensen
  2. Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset–Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France.

    • Séverine Mazaud-Guittot
    • , Pierre Gaudriault
    • , Laurianne Lesné
    • , Tania Serrano
    •  & Bernard Jégou
  3. Ecole des hautes études en santé publique (EHESP), Avenue Léon Bernard, F-35043 RENNES, France.

    • Tania Serrano
    •  & Bernard Jégou
  4. Department of Growth and Reproduction, University of Copenhagen, Section GR5064, Blegdamsvej 9, Rigshospitalet, DK-2100 Copenhagen, Denmark.

    • Katharina M. Main

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Contributions

D.M.K., S.M.-G., P.G., L.L., T.S., and B.J. researched data for the article. D.M.K., S.M.-G., K.M.M. and B.J. made substantial contributions to discussions of the content. D.M.K., S.M.-G. and B.J. wrote the article. D.M.K., S.M.-G., L.L., K.M.M. and B.J. reviewed and/or edited the article before submission.

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The authors declare no competing financial interests.

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Correspondence to David M. Kristensen or Bernard Jégou.

Supplementary information

PDF files

  1. 1.

    Supplementary S1 (table)

    The history of consumption of analgesics by pregnant women.

  2. 2.

    Supplementary S2 (figure)

    Worldwide consumption of mild analgesics during pregnancy.

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DOI

https://doi.org/10.1038/nrendo.2016.55

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