Is meloxicam (nonsteroidal anti-inflammatory drug, NSAID) safe to use during pregnancy?

Meloxicam Use During Pregnancy

Meloxicam is contraindicated during pregnancy, especially in the third trimester, due to significant fetal risks including premature closure of the ductus arteriosus and oligohydramnios. 1, 2

Safety by Trimester

• First trimester: While early pregnancy exposure to NSAIDs generally shows no evidence of increased risk of miscarriage or teratogenicity, meloxicam has limited safety data compared to better-studied NSAIDs like ibuprofen 1, 2
• Second trimester: Short-term use (7-10 days) of NSAIDs appears to pose minimal risk, but long-term use in late second trimester can cause oligohydramnios and ductus arteriosus constriction 1, 3
• Third trimester: NSAIDs including meloxicam must be discontinued after gestational week 28 (end of second trimester) due to increased risk of:
  • Premature closure of the fetal ductus arteriosus 1, 2
  • Oligohydramnios (reduced amniotic fluid) 1, 2
  • Pulmonary hypertension in the newborn 2, 4

Recommendations for Pain Management in Pregnancy

• Acetaminophen (paracetamol) is the preferred analgesic during pregnancy, considered safe in all trimesters 5
• If an NSAID is absolutely necessary during the first or second trimester:
  • Ibuprofen has the most reassuring safety data 1, 2
  • Diclofenac is considered the second safest option based on available evidence 2
  • Use the lowest effective dose for the shortest duration possible (7-10 days) 1, 2

Additional Considerations

• NSAIDs can interfere with ovulation and may reduce fertility in women trying to conceive due to luteinized unruptured follicle syndrome 1, 2
• The American College of Rheumatology strongly recommends against use of NSAIDs in the third trimester 1
• For women with inflammatory conditions requiring long-term treatment, pregnancy-compatible alternatives include:
  • Hydroxychloroquine 1
  • Sulfasalazine (with folate supplementation) 1
  • Low-dose glucocorticoids (≤10 mg daily of prednisone) 1
  • Azathioprine 1
  • Colchicine 1

Clinical Decision Making

• For acute pain management in pregnancy: acetaminophen is first-line 5
• For inflammatory conditions requiring treatment during pregnancy: consult with rheumatology and maternal-fetal medicine to transition to pregnancy-compatible medications 1
• If meloxicam exposure has already occurred:
  • First/second trimester: discontinue and switch to safer alternatives 1, 2
  • Third trimester: immediate discontinuation and fetal assessment for ductal constriction and oligohydramnios 1, 2, 3

Conclusion

Meloxicam should be avoided throughout pregnancy when possible, with absolute contraindication after gestational week 28. For women requiring anti-inflammatory treatment during pregnancy, safer alternatives should be used under specialist guidance 1, 2.