Aspirin vs acetaminophen, creatine, and round ligament pain

Welcome to the weekly ZIP - your Zenith Informed Pregnancy!

Read on for a quick zip through 3 of the week’s most popular pregnancy questions, and the evidence behind them. Plus - bonus content on the latest & greatest in the world of pregnancy research. 

This week's top pregnancy questions:

1️⃣ Ibuprofen vs aspirin vs acetaminophen?

2️⃣ Is creatine safe or useful during pregnancy?

3️⃣ What is round ligament pain?

Note: with Monday’s headlines, every version imaginable combination of the terms “Tylenol,” “acetaminophen,” “safe during pregnancy,” and “autism” was being searched across the internet, including with Penny. We’re not including it in this edition, as we just reviewed the evidence in our September 12th edition - which you can read here (or see Penny’s summary directly) if you missed it!

Ibuprofen vs. aspirin vs. acetaminophen?

Of course Tylenol has been trending over the past week, but there’s also been a flurry of inquiry about the other options for pain relief during pregnancy. Searches for medications like ibuprofen (often used in the brand form Advil) or aspirin are on the rise - lots of moms want to know if these are safe alternatives if they choose not to take Tylenol.

📚The tl;dr from the evidence: The evidence isn’t perfectly conclusive, but there is signal from the data indicating elevated risk profiles of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin as compared to acetaminophen (Tylenol) when looking at the potential for pregnancy complications and adverse outcomes for the baby. Especially after 20 weeks of pregnancy, standard doses of NSAIDs have been observed to lead to bleeding complications, kidney issues, low levels of amniotic fluid,  and potentially even birth defects, although the evidence supporting elevated birth defect risk is weaker.

But wait - isn’t aspirin recommended for women with elevated preeclampsia risk? The key distinction is the dose. 

Baby aspirin, or low dose aspirin, is a well-studied intervention to help delay or prevent the onset of preeclampsia and has been shown to be safe and effective. The lower dose (typically 81 mg/daily, as compared to 325 mg/daily as a standard dose) is not enough to provide pain relief like Tylenol or a standard dose of aspirin, but does provide benefit specific to women who are more likely to develop preeclampsia due to its anti-platelet (blood-thinning) effects.

👀Read Penny’s full summary of the evidence for more on NSAIDs vs Tylenol

Is creatine safe or useful during pregnancy?

Creatine supplementation is currently one of the hotter trends in health and wellness, which is a welcome one: unlike many wellness fads, there’s actually fairly conclusive evidence showing benefit in the general population. But as with many other popular interventions that women use and love – what about during pregnancy? Many women using the supplement are wondering if there are any risks (or benefits!) of continuing during pregnancy.

📚The tl;dr from the evidence:  There aren’t super robust studies (read: large randomized controlled trials) on creatine specifically during pregnancy, but the data we do have suggests that creatine is likely safe for use during pregnancy when taken at standard doses (~3-5 g/day). 

While more research is needed to identify potential causal links, there are some indications of even a potential benefit of creatine supplementation during pregnancy! The key benefits in pregnancy aren’t focused on athletic performance, muscle mass or increased strength, but rather as a potential preventative measure and indicator of improved outcomes for the baby, particularly those in riskier pregnancies. 

Some observational studies have seen higher maternal creatine levels associated with better fetal growth and birth outcomes (although, as a friendly reminder we’ve heard all week - correlation does not equal causation!). Animal studies have shown that maternal creatine can actually help protect the fetal brain and organs from injury due to low oxygen at birth – so there’s some research interest in creatine for pregnancies at risk of complications like fetal growth restriction or preeclampsia, where fetal oxygen delivery may be compromised. 

👀Read Penny’s full summary of the evidence for more on creatine supplementation while pregnant

What is round ligament pain?

Often starting in the second trimester - coinciding with when many moms begin to share their pregnancy journeys more broadly - round ligament pain can come on quickly and feel quite surprising and even concerning for first time moms. It’s a common topic across social media and online forums, as many seek advice on knowing the signs of round ligament pain vs other pains or cramps, and how to ease this symptom. 

📚The tl;dr from the evidence: Although unpleasant, round ligament pain is both common and normal during pregnancy, and on its own does not indicate any increased risks or harms for mom or baby. It feels like a sharp, sudden pain or ‘pulling’ feeling on one or both sides of the lower belly or groin area. The good news is that it is brief in nature, lasting seconds or minutes and is typically relieved with rest or even shifting position. 

The pain is a concern if it is more persistent, severe, or getting worse, and/or showing up alongside other symptoms like bleeding, fever, nausea, pain urinating, or dizziness – experiencing these additional symptoms or not finding relief with rest is a good signal to check in with your doctor to figure out what else might be going on.  

The culprit? Yep…your round ligaments, which are bands on each side of your uterus. The pain comes on during pregnancy as your uterus expands and causes these ligaments to stretch, often as a result of a sudden or sharp movement (like getting out of bed, sneezing, or coughing). 

👀Read Penny’s full summary of the evidence for more on round ligament pain

🤓 Zenith's top read of the week

Bonus: what the Zenith team found interesting this week. Think cool pregnancy research or recently published studies, news in pregnancy health and policy, and more!

Pregnant Women Are Turning to Cannabis to Ease Pain and Anxiety (Julie Wernau, Wall Street Journal) - There’s a lot of talk and debate about the safety of medications (whether prescription - like antidepressants, or OTC - like acetaminophen) during pregnancy due to the generally limited data and research behind them, but equally important is the lack of evidence behind alternative interventions that are being increasingly used by pregnant people, like cannabis. 

While it may feel easy to pass judgment on moms turning to unproven remedies in pregnancy,  it’s important to consider that the trends in use of alternative approaches is also a signal indicating the need for safe, effective, accessible support for the very real symptoms and experiences of pregnancy. Most women cited using cannabis for medical reasons related to pregnancy, and as we all know well, there is not currently a sufficient set of safe and effective alternatives – especially thinking about extreme symptoms or complications, like hyperemesis gravidarum (aka severe nausea & vomiting of pregnancy). 

We must invest in more research, both for traditional medicines and alternative approaches to pain and symptom management, to both clarify the safety of currently available options but also to explore new medicines or interventions that can ease the effects of symptoms. 

Key excerpt:

“In a 2022 survey of 3,571 pregnant and recently pregnant women, about 17% said they’d used cannabis at least once during pregnancy. More than half said they were using it exclusively for medical reasons. Top among them were stress and anxiety, nausea, lack of sleep, vomiting and pain. Others cited the cost of access to medical professionals versus that of cannabis.”

🎁 And another bonus read of the week, including a feature on Zenith’s work: 

The Latest in Maternal Health Fear Mongering? Tylenol (Fiorella Valdesolo, Vogue) – explores the real impact that the lack of clarity in the Tylenol headlines is having on women. While we might not yet have perfect data to answer “is there a causal link between Tylenol and autism,” it’s important to keep the dialogue balanced with the best data we do have. This piece implores us all to lead with curiosity and scientific inquiry (rather than anxiety-inducing pronouncements) for moms who are already doing everything they can to keep themselves and their babies healthy.