non-steroidal anti-inflammatory drugs (NSAIDs) in pregnancy

Last edited 06/2023 and last reviewed 07/2023

Non-steroidal anti-inflammatory drugs (NSAIDs) in pregnancy

• non-steroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen

  • non-steroidal anti-inflammatory (NSAID) may be an additional option for some pregnant women in their first or second trimesters (1)
    • NSAIDs should not be used in the third trimester.
  • most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk
    • should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn
      • NSAIDs are contraindicated in the third trimester of pregnancy (2)
        • should not be used from week 28 of pregnancy
          • is due to the increased risks of constriction of the ductus arteriosus and renal dysfunction, which are greater in the last trimester
          • NSAIDs may also increase bleeding time owing to their anti-platelet-aggregating effect on platelets and may inhibit uterine contractions, resulting in delayed or prolonged labour
        • updated guidance suggests that should be avoided if possible from week 20 of pregnancy (3)
          • review of data from a 2022 study has identified that prolonged use of NSAIDs from week 20 of pregnancy onwards may be associated with an increased risk of oligohydramnios (low levels of amniotic fluid surrounding the baby) and fetal renal dysfunction
          • some cases of constriction of the ductus arteriosus (narrowing of a connecting blood vessel in the baby’s heart) have also been identified at this early stage
          • avoid prescribing systemic NSAIDs from week 20 of pregnancy unless clinically required and prescribe the lowest dose for the shortest time in these circumstances
          • antenatal monitoring for oligohydramnios should be considered if the mother has been exposed to NSAIDs for several days after week 20 of pregnancy; the NSAID should be discontinued if oligohydramnios is found or if the NSAID is no longer considered to be clinically necessary
    • onset of labour may be delayed and its duration may be increased
    • studies have failed to show consistent evidence of increased teratogenic effects in either humans or animals following therapeutic doses during the first trimester (2)

Reference:

• NHS Specialist Pharmacy Service (August 2022). Using opioids for pain relief during pregnancy
• Babb M et al. Treating pain during pregnancy.Can Fam Physician. 2010 Jan;56(1):25, 27.
• Drug Safety Update volume 16, issue 11: June 2023: 2.