What are the risks of taking Advil (ibuprofen) during pregnancy?

Risks of Taking Advil (Ibuprofen) During Pregnancy

Advil (ibuprofen) should be avoided during pregnancy, particularly after 20 weeks gestation, due to serious fetal risks including premature closure of the ductus arteriosus, oligohydramnios, and potential miscarriage in early pregnancy. 1

Critical Timing-Based Risks

Early Pregnancy (Conception through First Trimester)

• Ibuprofen use around conception increases miscarriage risk by 59% compared to non-users (adjusted hazard ratio 1.59), with the risk rising to nearly 4-fold for early miscarriages occurring before 8 weeks gestation 2
• A dose-response relationship exists: use for ≥15 days around conception increases miscarriage risk by 85% (adjusted hazard ratio 1.85) 2
• Women with lower body mass index (<25 kg/m²) face particularly elevated risk, with nearly 4-fold increased miscarriage risk when using NSAIDs around conception 2
• Women actively trying to conceive should completely avoid ibuprofen, as continuous periovulatory exposure can induce luteinized unruptured follicle syndrome, interfering with ovulation and reducing fertility 3

Second Trimester (14-27 Weeks)

• If absolutely necessary, ibuprofen may be used cautiously at the lowest effective dose for short durations (7-10 days maximum) 3
• All ibuprofen use must be discontinued by gestational week 28, not simply "third trimester," as fetal sensitivity to NSAID-related risks increases significantly after this point 3
• Second-trimester use has been associated with fetal cryptorchism (undescended testicles) 4

Late Pregnancy (After 20-30 Weeks)

• The FDA mandates that ibuprofen use at about 30 weeks gestation or later increases risk of premature closure of the fetal ductus arteriosus 1
• Use at about 20 weeks gestation or later has been associated with fetal renal dysfunction leading to oligohydramnios (low amniotic fluid), and in some cases, neonatal renal impairment 1
• If ibuprofen treatment extends beyond 48 hours after 20 weeks, ultrasound monitoring for oligohydramnios should be considered 1

Comprehensive Fetal and Neonatal Risks

Cardiovascular System

• Premature constriction or closure of the ductus arteriosus, potentially leading to persistent pulmonary hypertension in the newborn 4
• This risk is particularly significant after 30 weeks gestation 1

Renal System

• Fetal renal injury and impaired kidney development 4
• Oligohydramnios (reduced amniotic fluid volume) due to decreased fetal urine production 1, 5
• Neonatal renal impairment that may persist after birth 1

Other Organ Systems

• Increased risk of intracranial hemorrhage in the fetus/newborn 4
• Necrotizing enterocolitis (severe intestinal inflammation) 4
• Potential skeletal, gastrointestinal, and brain effects 5

Maternal Risks Near Term

• Prolonged gestation and labor from inhibition of prostaglandin synthesis 6
• Increased peripartum blood loss and anemia 6

Evidence Quality and Nuances

Important caveat: One large German cohort study of 1,117 women exposed to ibuprofen in the first trimester found no significantly increased risk of major birth defects (4.8% vs 4.1%) or spontaneous abortions (15.5% vs 16.6%) 7. However, this contradicts the more robust 2018 Kaiser Permanente study that controlled for confounding by indication and found significant miscarriage risk 2. The weight of evidence, including FDA labeling and multiple guidelines, supports avoiding ibuprofen during pregnancy 1, 3.

Safer Alternatives

• Acetaminophen is the recommended first-line analgesic throughout all trimesters of pregnancy, as it does not cause premature ductus arteriosus closure or oligohydramnios 8, 3
• Acetaminophen should be used at the lowest effective dose for the shortest duration, ideally ≤7 days, with a maximum daily dose of 4 grams to avoid hepatotoxicity 8
• For chronic inflammatory conditions requiring ongoing treatment, pregnancy-compatible alternatives include hydroxychloroquine, sulfasalazine, low-dose prednisone, or azathioprine 3

Common Pitfalls to Avoid

• Many pregnant women incorrectly believe ibuprofen is safe in late pregnancy: over 10% of surveyed pregnant women thought NSAIDs were safe in late pregnancy, and many did not recognize that aspirin and ibuprofen are NSAIDs 9
• Self-medication with over-the-counter ibuprofen is common but dangerous 5, 9
• The critical cutoff is gestational week 28 (not the traditional "third trimester" designation at week 27-28), and some risks begin as early as 20 weeks 3, 1
• Ibuprofen is considered safe during breastfeeding, as it transfers in low amounts to breast milk 3, 4