From the Guidelines
Topical NSAIDs can be used during pregnancy, but with caution and only during the second trimester, as they are generally considered safer than oral NSAIDs due to lower systemic absorption. When considering the use of topical NSAIDs during pregnancy, it's essential to weigh the potential benefits against the risks. The most recent and highest quality study, 1, provides guidance on the management of reproductive health in rheumatic and musculoskeletal diseases, including the use of NSAIDs during pregnancy. According to this study, NSAIDs are conditionally recommended for use during pregnancy, but their use should be discontinued in the third trimester due to the risk of premature closure of the ductus arteriosus. Some key points to consider when using topical NSAIDs during pregnancy include:
- Using the lowest effective dose for the shortest duration necessary
- Avoiding use in the third trimester
- Considering alternative pain management strategies, such as acetaminophen (Tylenol)
- Consulting with a healthcare provider before using any medication during pregnancy It's also important to note that the safety advantage of topical NSAIDs comes from their lower systemic absorption compared to oral forms, resulting in lower blood levels and reduced fetal exposure, as mentioned in 1 and 1. However, even with topical application, some medication is still absorbed into the bloodstream, so caution is still necessary. Ultimately, the decision to use topical NSAIDs during pregnancy should be made in consultation with a healthcare provider, taking into account the individual's specific situation and the potential risks and benefits.
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. Fetal Toxicity: Limit use of NSAIDs, including diclofenac sodium topical solution, between about 20 to 30 weeks in pregnancy due to the risk of oligohydramnios/fetal renal dysfunction. Avoid use of NSAIDs in women at about 30 weeks gestation and later in pregnancy due to the risks of oligohydramnios/fetal renal dysfunction and premature closure of the fetal ductus arteriosus
Topical NSAIDs are not safe during pregnancy, especially after 30 weeks of gestation, due to the risk of fetal toxicity and other complications. Use between 20 and 30 weeks of pregnancy should be limited and monitored by a healthcare provider 2, 2.
From the Research
Topical Non-Steroidal Anti-Inflammatory Drug (NSAID) Safety During Pregnancy
- The safety of topical NSAIDs during pregnancy is not directly addressed in the provided studies, which primarily focus on systemic NSAID use 3, 4, 5, 6, 7.
- However, one study suggests that local dermatological formulations of NSAIDs may potentially cause ductus arteriosus constriction in the fetus, indicating a possible risk associated with topical NSAID use during pregnancy 6.
- Another study reports on cases of prenatal ductus arteriosus constriction related to maternal pain medication, including ibuprofen, but does not specifically address topical NSAID use 7.
- The majority of the studies emphasize the importance of considering the potential fetal risks associated with NSAID use during pregnancy, particularly in the third trimester, and recommend that NSAIDs be given only if the maternal benefits outweigh the potential fetal risks, at the lowest effective dose and for the shortest duration possible 3, 4, 5.
Fetal Risks Associated with NSAID Use
- Systemic NSAID use during pregnancy has been associated with various fetal risks, including:
- Increased risk of miscarriage and malformations in early pregnancy 4
- Premature closure of the fetal ductus arteriosus and oligohydramnios after 30 weeks' gestation 4, 5
- Fetal cryptorchism in the second trimester 3
- Renal injury, necrotizing enterocolitis, and intracranial hemorrhage in the third trimester 3
- The studies suggest that the risk of fetal adverse effects depends on the type of NSAID, the dose and duration of therapy, and the period of gestation 4, 5, 6.