Aspirin and ibuprofen can cause problems for pregnant women

Along with deli meat, raw seafood and soft cheeses, nonsteroidal anti-inflammatory drugs (NSAIDs) are included on the no-no list for pregnant women. The FDA recently reissued guidelines that pregnant women should not take NSAIDs (aspirin, ibuprofen, etc.) after 20 weeks of pregnancy because they could cause harm to the developing fetus.

This is not new news to obstetrician Richard Heywood, DO at Falmouth Women’s Health, but over the past 10 years, he says, more obstetricians have tolerated the use of NSAIDs in their pregnant patients, especially early on. He believes that’s why the FDA felt the need to reinforce this statement.

“I feel the best answer has always been just don’t take non-steroidals in pregnancy,” he said. “My position has been just avoid them. That’s my feeling with many things in pregnancy. Unless you absolutely have to do it, don’t take the risk.”

The problem with NSAIDs is that they are metabolized by the kidneys in the growing fetus, which can cause health issues.

“It can really cause some significant problems,” Dr. Heywood said. “They can affect the function of the fetal kidneys and therefore the amniotic fluid, which therefore affects lung development and skeletal evolvement, if there is not enough amniotic fluid.”

Amniotic fluid is necessary for lung development, which is always a concern later in the pregnancy. But that’s not the only risk.

“The thing that’s probably a bigger concern is that using NSAIDs later in pregnancy can affect something called the ductus arteriosus,” Dr. Heywood said.

Blood flow in a fetus is shunted through the heart. Most of the blood is not actually going through the lungs, so the lungs are not oxygenating the blood. That’s the job of the placenta. The ductus arteriosus is basically a bypass that allows the blood to skip the lungs. This begins to close naturally at the moment of birth, he said.

“Using NSAIDs later in the pregnancy can cause that to close prematurely,” he said. “Basically, it causes fetal circulation to start pushing blood into the fetal lungs, causing pulmonary hypertension. Then you can start to have other issues, including fetal death.”

What to Avoid

NSAIDs that should be avoided during pregnancy include:

• Aspirin
• Celebrex
• Diclofenac
• Ibuprofen (Motrin and Advil)
• Naproxen
• Indomethacin
• Mefenamic acid

Women should keep in mind that many over-the-counter medicines for colds, flu and insomnia contain NSAIDs, so they should read all labels carefully. Women can safely take acetaminophen for fever or pain, Dr. Heywood said. It is also permissible for women to take a low-dose aspirin, if directed by the doctor, for the prevention of pre-eclampsia.

There are other more holistic things women can do if they are having pain issues. For back and pelvic pain, Dr. Heywood does osteopathic manipulations. He often refers patients to massage therapy or physical therapy. He also believes in the RICE treatment that consists of Rest, Ice, Compression and Elevation for injuries, like sprains. If someone is in significant pain, he may refer them to a pain specialist for treatments, such as injections.

The official caveat is that if NSAIDs are needed between 20 and 30 weeks of pregnancy, limit it to the lowest effective dose for the shortest duration, he added.