Ketorolac is Not Safe for Use During Pregnancy at 14 Weeks
Ketorolac should not be used during pregnancy at 14 weeks gestation due to potential fetal risks, despite being in the second trimester. 1, 2
Safety of NSAIDs in Pregnancy by Trimester
- While NSAIDs can be used with caution during the first and second trimesters, ketorolac specifically carries higher risks compared to other NSAIDs due to its potency 1, 3
- The American College of Rheumatology conditionally recommends nonselective NSAIDs over COX-2 inhibitors in the first 2 trimesters, but with important restrictions 2
- NSAIDs should only be used for short durations (7-10 days) at the lowest effective dose when absolutely necessary during pregnancy 2, 3
- Most safety data for NSAIDs in pregnancy is available for ibuprofen and diclofenac, with very limited data on ketorolac 3, 2
Specific Concerns with Ketorolac in Pregnancy
- Ketorolac is contraindicated in labor and delivery because it may adversely affect fetal circulation and inhibit uterine contractions 1
- The FDA drug label for ketorolac specifically mentions that it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus 1
- Ketorolac is associated with higher risks of gastrointestinal bleeding and renal impairment compared to other NSAIDs, making it a particularly poor choice during pregnancy 4
- A 2023 nationwide cohort study found that NSAID exposure during early pregnancy was associated with slightly increased risks of major congenital malformations, low birth weight, and oligohydramnios 5
Safer Alternatives for Pain Management in Pregnancy
- If pain management is necessary during pregnancy, consider acetaminophen as a first-line agent 2, 3
- If an NSAID is absolutely required, ibuprofen has the most reassuring safety data for use during pregnancy (first and second trimesters) 3, 2
- For severe pain requiring stronger medication, consult with both obstetrics and pain management specialists to develop a safer treatment plan 2
Important Precautions
- All NSAIDs must be discontinued after gestational week 28 (end of second trimester) due to risk of premature closure of the ductus arteriosus and oligohydramnios 2, 6
- NSAIDs can interfere with ovulation and may reduce fertility in women trying to conceive 2, 3
- The risks of adverse neonatal and maternal outcomes are higher with longer duration of NSAID use (>10 days) 5
Conclusion
While some NSAIDs may be used cautiously during the second trimester of pregnancy, ketorolac specifically carries higher risks than other options and should be avoided. The FDA drug label clearly states that ketorolac should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus 1. Given the availability of safer alternatives like acetaminophen or, if necessary, ibuprofen for short-term use, ketorolac should not be administered to a patient at 14 weeks gestation.