What are the effects of Ibuprofen (Nonsteroidal Anti-Inflammatory Drug, NSAID) on pregnancy?

From the Guidelines

Ibuprofen should be avoided during pregnancy, especially in the third trimester, due to the risk of premature closure of the ductus arteriosus and other potential fetal complications. Here's what you need to know:

• Avoid ibuprofen in the third trimester (after 28 weeks) as it can cause serious complications for the baby, including premature closure of the ductus arteriosus, as recommended by the 2020 American College of Rheumatology guideline 1.
• In the first and second trimesters, occasional use of ibuprofen may be okay, but only under a doctor's guidance, with a recommended maximum dose of 400mg every 6-8 hours, not exceeding 1200mg per day, as suggested by the American Family Physician study 1.
• Acetaminophen (Tylenol) is usually the preferred pain reliever during pregnancy, with a typical dose of 500-1000mg every 4-6 hours, not exceeding 4000mg per day.
• Always consult your healthcare provider before taking any medication during pregnancy, as they can help weigh the potential risks and benefits of ibuprofen use during this critical period. Ibuprofen can potentially cause problems with fetal kidney function and reduce amniotic fluid levels, and may also delay labor and cause a blood vessel in the baby's heart to close prematurely, as noted in the American Family Physician study 1. These risks increase significantly in late pregnancy, which is why it's crucial to avoid ibuprofen in the third trimester, as strongly recommended by the 2020 American College of Rheumatology guideline 1.

From the FDA Drug Label

Use of NSAIDs, including ibuprofen tablets, can cause premature closure of the fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment Because of these risks, limit dose and duration of ibuprofen tablets use between about 20 and 30 weeks of gestation, and avoid ibuprofen tablets use at about 30 weeks of gestation and later in pregnancy Premature Closure of Fetal Ductus Arteriosus: Avoid use of NSAIDs in women at about 30 weeks gestation and later in pregnancy, because NSAIDs, including ibuprofen tablets, can cause premature closure of the fetal ductus arteriosus Oligohydramnios/Neonatal Renal Impairment If an NSAID is necessary at about 20 weeks gestation or later in pregnancy, limit the use to the lowest effective dose and shortest duration possible.

The effects of Ibuprofen on pregnancy include:

• Premature closure of the fetal ductus arteriosus: Ibuprofen can cause premature closure of the fetal ductus arteriosus, particularly when used after 30 weeks of gestation.
• Fetal renal dysfunction: Ibuprofen can cause fetal renal dysfunction, leading to oligohydramnios and, in some cases, neonatal renal impairment.
• Oligohydramnios: Ibuprofen can cause oligohydramnios, particularly when used after 20 weeks of gestation. To minimize these risks, the use of ibuprofen should be:
• Limited in dose and duration: Between 20 and 30 weeks of gestation.
• Avoided: After 30 weeks of gestation. It is recommended to monitor for oligohydramnios if ibuprofen treatment extends beyond 48 hours 2, 2.

From the Research

Effects of Ibuprofen on Pregnancy

• Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is commonly used for pain relief during pregnancy 3, 4, 5, 6, 7.
• The use of NSAIDs, including ibuprofen, in early pregnancy has been associated with increased risks of miscarriage and malformations 3, 4.
• In the second trimester, the use of NSAIDs is considered reasonably safe, but has been linked to fetal cryptorchism 3.
• In the third trimester, NSAIDs, including ibuprofen, are usually avoided due to significant fetal risks such as renal injury, oligohydramnios, constriction of the ductus arteriosus, and intracranial hemorrhage 3, 4, 5.
• Ibuprofen is contraindicated after 28 weeks of gestation due to the increasing risk of premature closure of the ductus arteriosus and impairment of fetal kidney function 5.

Maternal and Fetal Risks

• The use of NSAIDs during pregnancy may affect fertility and increase the risk of early pregnancy loss 3.
• Fetal and neonatal adverse effects, including those affecting the brain, kidney, lung, skeleton, gastrointestinal tract, and cardiovascular system, have been reported after prenatal exposure to NSAIDs 4.
• Maternal administration of NSAIDs results in low infant exposure via breastmilk, and cyclooxygenase-1 and cyclooxygenase-2 inhibitors are generally considered safe when breastfeeding 3.

Guidelines for Use

• NSAIDs, including ibuprofen, should be given in pregnancy only if the maternal benefits outweigh the potential fetal risks, at the lowest effective dose and for the shortest duration possible 4.
• Paracetamol is the agent of choice for mild to moderate pain in any stage of pregnancy, while ibuprofen is the NSAID of choice, but with restrictions in the third trimester 5, 6.