This is important for our readers that treat pain patients.
Author: Zawn Villines
Aches and pains are common throughout pregnancy, and some people take pain relievers to reduce their discomfort. However, experts recommend that pregnant individuals avoid ibuprofen (Advil) after 20 weeks.
This recommendation comes from the Food and Drug Administration (FDA). Additionally, some research suggests a link between taking ibuprofen in pregnancy and problems with fetal development (commonly known as birth defects) even when taken before 20 weeks.
For this reason, the American College of Obstetricians and Gynecologists (ACOG) discourages people from taking ibuprofen during pregnancy.
People experiencing pain during pregnancy should contact a doctor to discuss the risks and benefits of medication. Pregnant individuals do not have to resign themselves to being in pain, and there are alternative options that can help.
Read more to learn about the risks of taking ibuprofen during pregnancy, alternative pain relief options, and when to contact a doctor.
No medication is safe in all circumstances for all pregnancies. Every drug a person takes carries some risk, and ibuprofen is no exception.
Research has established that ibuprofen can be risky after the midpoint of pregnancy, which is about 20 weeks. The FDA advises against using ibuprofen after this point in pregnancy because doing so may damage the fetus’s kidneys, causing low amniotic fluid.
Additionally, some evidence suggests ibuprofen may increase the risk of problems with fetal development. A 2017 study using 15 years of data found that people who took opioids, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) had higher rates of fetal development problems than those who took acetaminophen (Tylenol). NSAIDs can close the fetal ductus arteriosus, a vital blood vessel that supports blood flow to the placenta.
Ibuprofen during pregnancy also correlates with fetal development problems such as:
- gastroschisis, a condition where the intestines are outside the body
- cleft lip and cleft palate, which are splits in the lip, roof of the mouth, or both
- spina bifida, a condition where the spinal cord does not develop correctly
- anencephaly, which is where the brain and skull do not develop completely
- hypospadias, a rare condition affecting the penis
However, the same 2017 study did not show that ibuprofen use caused these fetal development problems. Other factors, such as the health conditions that caused a person to use ibuprofen may explain them.
Ibuprofen, as with other NSAIDs, thins the blood. This means it takes longer for blood to clot, which can increase a person’s bleeding risk. For most people, this is not a problem, but it could be an issue for people with low platelets and those at a high risk of hemorrhage (heavy bleeding).
Ibuprofen crosses the placenta, which means these effects can pass to the fetus. It can interfere with the fetus’s platelet function, making it more prone to bleeding.
Hemorrhaging after giving birth is fairly common, affecting 3–8% of people who give birth. For this reason, people should not take blood-thinning medications in the later stages of pregnancy. If a person is not sure whether it is safe to take a mediation, they should contact a doctor.
During the early stages of pregnancy, the risks of using ibuprofen are at their lowest. This is when the medication is less likely to cause low amniotic fluid. The blood-thinning effects are also less dangerous as the individual is not about to give birth.
However, there is no evidence that ibuprofen is safe at any stage of pregnancy.
Some research has shown a connection between ibuprofen use and problems with fetal development, and most fetal development problems happen because of exposure to harmful substances during the first 3 months of pregnancy. This means pregnant individuals should be aware of the potential risks of ibuprofen during their first trimester.
However, there may be instances when the benefits of ibuprofen outweigh the risks. This could happen when a person is in severe pain and is not able to safely take other medications.
For example, ibuprofen and other NSAIDs may be helpful for people with fibroids that cause severe pain. People in this situation should contact a doctor to discuss the best option for their pregnancy.
In general, using ibuprofen at the lowest effective dose for the shortest period of time will pose the smallest risk, though there is no way to completely eliminate the risks.
Most doctors recommend acetaminophen (paracetamol) for pain relief during pregnancy. However, that does not mean acetaminophen does not pose risks.
A 2021 statement published in Nature Reviews Endocrinology suggests that acetaminophen may increase the risk of certain fetal development problems. People considering using it should weigh the risks and benefits, and they should contact a doctor before starting any new medication.
For many people, non-medication pain relief is an effective alternative to drugs. Some options include:
- Supportive clothing and girdles: Additional support for the uterus and pelvic floor may relieve back and hip pain.
- Physical therapy: This may ease pregnancy-related joint pain and injuries.
- Relaxation techniques: Progressive muscle relaxation and meditation reduce tension and stress, which can help a person manage their pain.
- Exercise and stretching: Remaining physically active may reduce the risk of certain types of pain.
- Alternative therapies: Some people find relief in acupuncture and massage. However, they should contact a doctor before trying alternative treatments.
A person may want to contact a doctor before taking any pain medication during pregnancy.
When they do so, they should mention the source of their pain. It may indicate an underlying health condition or pregnancy complication.
For example, many people experience pubic symphysis pain in pregnancy. This can cause intense shooting pains in the pelvis. However, the correct treatment, such as physical therapy, can help relieve a person’s symptoms. Support belts, as well as going up and down stairs backward, may reduce discomfort.
Pain during pregnancy can be uncomfortable and frightening. While ibuprofen is a common medication for pain relief, the ACOG discourages people from taking it during pregnancy.
If people experience ongoing pain, they may want to contact a doctor or midwife. They can recommend alternative treatments and medications that can help manage a person’s symptoms.