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According to the authors of a new article published in American Journal of Obstetrics and Gynecology, the answer may be yes.

When pre-term labor starts, physicians are primarily concerned about the possibility that the baby won’t be able to breathe on its own yet. Often, the mother is given a tocolytic agent (medicine to stop labor), followed by a steroid to speed up the development of the baby’s lungs. After the steroid has had enough time to work, the tocolytic medicine will be stopped. The mother may go into labor again shortly thereafter.

Dr. Sanjiv Amin and his colleagues at the University of Rochester Medical Center (URMC) investigated whether a common tocolytic agent known as indomethacin had any impact on the subsequent health of preterm babies. Although dozens of studies have been done on indomethacin, none have had a large sample size or definitive outcomes. So, the URMC researchers performed a meta-analysis of available studies.

The research team found that use of indomethacin to stop labor increased the risk of two conditions: periventricular leukomalacia and necrotizing enterocolitis.

Both of these conditions are as serious as their names are frightening. Periventricular leukomalacia is a white matter injury caused by decreased blood flow to the brain, which can lead to cerebral palsy. Necrotizing enterocolitis is a condition in which intestinal tissue dies. It can be treated with antibiotics, but it often requires surgery and can result in infant death.

The research team also found that the use of indomethacin to stop labor did not increase the risk of intraventricular hemorrhage (bleeding in the brain), patent ductus arteriosus (a congenital heart defect), respiratory distress syndrome (a life-threatening lung disorder) or fetal death.

Indomethacin is a popular tocolytic agent that is used by many obstetricians who believe that it is more effective and has fewer side effects for the mother than other, more commonly used tocolytic agents. The URMC research team hopes that the results of this study will cause obstetricians to re-think their decision.

In the words of study co-author Christopher Glantz, MD MPH, obstetricians should use indomethacin “only on those who need it most”—women who are in labor very early or whose babies are at the highest risk of problems related to prematurity.

The choice is between “a rock – a baby who could benefit from more time in the womb – and a hard place – a baby who may develop problems because of drugs like indomethacin that may provide extra time in the womb,” according to Glantz.

Faced with this situation, obstetricians must consider the options carefully. They must make an informed decision after weighing the risks and benefits of each available medicine, including this new information about the risks of indomethacin.

In this, as when faced with other medical conditions, pregnant women must keep in mind three questions:

• What treatments (medicines) are available?
• What are the risks of each for me?
• What are the risks of each for my baby?