Is ibuprofen safe to use during pregnancy?

Ibuprofen Safety in Pregnancy

Ibuprofen can be used cautiously during the first and second trimesters (up to 28 weeks) at the lowest effective dose for short durations (7-10 days maximum), but must be completely avoided after 28 weeks gestation due to serious fetal risks including premature ductus arteriosus closure, oligohydramnios, and neonatal renal impairment. 1, 2

Timing-Based Safety Profile

Before Conception and Early Pregnancy

• Women actively trying to conceive should avoid ibuprofen entirely, as NSAIDs can block ovulation by inducing luteinized unruptured follicle syndrome and interfere with blastocyst implantation. 3, 1, 4
• First trimester exposure shows no evidence of increased risk of miscarriage or major birth defects when used appropriately for short durations. 1, 5

First and Second Trimesters (Up to 28 Weeks)

• Ibuprofen may be prescribed at 200-400mg every 6-8 hours for a maximum of 7-10 days if acetaminophen (the first-line agent) is insufficient. 1, 6
• Use the lowest effective dose for the shortest possible duration. 1, 2
• Ibuprofen has the most reassuring safety data among NSAIDs during this period. 1

After 28 Weeks Gestation Through Delivery

• Ibuprofen is strictly contraindicated after gestational week 28-30. 1, 2, 6
• The FDA specifically warns to avoid ibuprofen at about 30 weeks gestation and later due to risk of premature closure of the fetal ductus arteriosus. 2
• If NSAID use is necessary at about 20 weeks or later, limit to lowest effective dose and shortest duration possible (ideally <48 hours), with ultrasound monitoring for oligohydramnios if treatment extends beyond 48 hours. 2

Specific Fetal and Neonatal Risks

Third Trimester Complications

• Premature closure or constriction of the ductus arteriosus, potentially leading to persistent pulmonary hypertension in the newborn. 2, 7, 8
• Oligohydramnios and fetal/neonatal renal dysfunction, which can occur after days to weeks of treatment, though cases have been reported as soon as 48 hours after initiation. 2, 7, 8
• Increased risk of necrotizing enterocolitis and intracranial hemorrhage in the newborn. 7

Maternal Risks Near Term

• Prolonged gestation and labor from inhibition of prostaglandin synthesis. 3, 1
• Increased peripartum blood loss and anemia. 3, 1

Clinical Decision Algorithm

Step 1: Determine gestational age

• If trying to conceive or <28 weeks: proceed to Step 2
• If ≥28 weeks: ibuprofen is contraindicated; use acetaminophen only 1, 2

Step 2: For pregnancies <28 weeks

• First-line: Acetaminophen 650-975mg every 6-8 hours 9
• If acetaminophen insufficient: Consider ibuprofen 200-400mg every 6-8 hours 1
• Maximum duration: 7-10 days 1
• Reassess necessity daily

Step 3: If NSAID use extends to 20+ weeks

• Limit to <48 hours if possible 2
• If >48 hours needed, monitor with ultrasound for oligohydramnios 2
• Discontinue immediately if oligohydramnios develops 2

Critical Pitfalls to Avoid

• The critical cutoff is 28 weeks, not the traditional "third trimester" designation (which begins at ~27 weeks), as fetal sensitivity to NSAID-related risks increases significantly after this point. 1
• Many women don't realize over-the-counter pain relievers like Advil contain ibuprofen and may not report their use—always ask specifically about brand names. 4
• Avoid combination cold medications that may contain NSAIDs to prevent inadvertent exposure. 3

Breastfeeding Safety

• Ibuprofen is considered safe during breastfeeding, as it transfers to breast milk in trace amounts only. 3, 1, 7
• Contraindicated only when breastfeeding a neonate with jaundice, as NSAIDs displace bilirubin. 3