From the Guidelines
NSAIDs should be used with caution during pregnancy, and their use is generally not recommended, especially in the first and third trimesters, due to potential risks to the fetus, as noted in the 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases 1. The use of NSAIDs during pregnancy has been associated with several risks, including miscarriage, birth defects, and premature closure of the ductus arteriosus, which can lead to pulmonary hypertension in the newborn.
- In the first trimester, NSAIDs like ibuprofen, naproxen, and celecoxib may increase the risk of miscarriage and birth defects.
- During the third trimester, these medications can cause premature closure of the ductus arteriosus, potentially leading to pulmonary hypertension in the newborn, and may also delay labor and increase bleeding risk. If pain relief is necessary during pregnancy, acetaminophen is typically considered the safest option at regular doses (500-1000mg every 6 hours, not exceeding 4000mg daily) 1.
- For pregnant women who absolutely require anti-inflammatory treatment, the lowest effective dose should be used for the shortest possible duration, ideally between weeks 16-30 of pregnancy when risks appear lowest.
- This recommendation stems from NSAIDs' mechanism of action - they inhibit prostaglandin synthesis, which plays important roles in fetal development, particularly cardiovascular development. Any use of NSAIDs during pregnancy should only occur after consultation with a healthcare provider who can weigh individual risks and benefits, as suggested by the American Academy of Pediatrics and other guidelines 1.
From the FDA Drug Label
Taking NSAIDs at about 20 weeks of pregnancy or later may harm your unborn baby If you need to take NSAIDs for more than 2 days when you are between 20 and 30 weeks of pregnancy, your healthcare provider may need to monitor the amount of fluid in your womb around your baby. You should not take NSAIDs after about 30 weeks of pregnancy. Inform pregnant women to avoid use of ibuprofen tablets and other NSAIDs starting at 30 weeks gestation because of the risk of the premature closing of the fetal ductus arteriosus If treatment with ibuprofen tablets is needed for a pregnant woman between about 20 to 30 weeks gestation, advise her that she may need to be monitored for oligohydramnios, if treatment continues for longer than 48 hours
Guidelines for using NSAIDs during pregnancy:
- NSAIDs should not be taken after 30 weeks of pregnancy.
- Between 20 and 30 weeks of pregnancy, NSAIDs can be taken for more than 2 days only under the supervision of a healthcare provider, with monitoring of the amount of fluid in the womb.
- NSAIDs may harm the unborn baby if taken at or after 20 weeks of pregnancy.
- Pregnant women should be advised to avoid NSAIDs starting at 30 weeks gestation due to the risk of premature closing of the fetal ductus arteriosus.
- Women taking NSAIDs between 20 and 30 weeks gestation may need to be monitored for oligohydramnios if treatment continues for more than 48 hours 2, 2.
From the Research
Guidelines for Using Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) During Pregnancy
- NSAIDs are widely used by pregnant women for pain relief, but their use is associated with potential risks to the fetus and newborn 3, 4.
- In the first trimester, NSAIDs may affect fertility and increase the risk of early pregnancy loss 3.
- In the second trimester, the use of NSAIDs is considered reasonably safe, but has been associated with fetal cryptorchism and other adverse effects 3, 5.
- Short-term use of NSAIDs as analgesics or antipyretics in the second trimester does not appear to pose a substantial risk for fetal adverse effects, but long-term use should be monitored 5.
- In the third trimester, NSAIDs are usually avoided due to significant fetal risks, including renal injury, oligohydramnios, constriction of the ductus arteriosus, and intracranial hemorrhage 3, 4, 6.
Safe Use of NSAIDs During Pregnancy
- NSAIDs 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.
- Maternal administration or ingestion of most NSAIDs results in low infant exposure via breastmilk, making them generally safe for breastfeeding women 3.
- However, even a low rate of NSAID use in the third trimester is considered alarmingly high due to the potential risks to the fetus and newborn 6.
Adverse Effects of NSAIDs on the Fetus and Newborn
- NSAIDs have been associated with various adverse effects on the fetus and newborn, including: