Full Circle Midwifery

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Ibuprofen and Pregnancy

This sheet talks about the risks that exposure to ibuprofen can have during pregnancy. With each pregnancy, all women have a 3% to 5% chance of having a baby with a birth defect. This information should not take the place of medical care and advice from your health care provider.

What is ibuprofen?

Ibuprofen is a nonsteroidal anti- inflammatory drug (NSAID) commonly used to treat arthritis, headaches, muscle aches, fever, and menstrual cramps. Other names for ibuprofen include Motrin®, Advil®, and Nuprin®. Ibuprofen is also an ingredient in many over-the-counter combination products.

I take ibuprofen regularly at high doses for my medical condition. Can this make it more difficult for me to become pregnant?

Two small studies have suggested an increased risk with the use of NSAIDs such as ibuprofen for one type of temporary female infertility called unruptured follicle syndrome. This occurs when the follicle (structure in which the egg grows) fails to release an egg at the time of ovulation, despite an otherwise normal cycle. This syndrome seems to be more likely to occur with chronic NSAID use. More research needs to be conducted in order to assess the risk of unruptured follicle syndrome with ibuprofen. As always, you should not stop taking a medication without first talking with your health care provider.

Is it true that taking ibuprofen early in pregnancy can increase the risk for miscarriage?

Two studies have found an increased risk of miscarriage with the use of NSAIDs early in pregnancy; however, several other studies did not find this association. There are also concerns that drugs such as ibuprofen may interfere with implantation of the early fetus. While a clear risk has not been established, women who are trying to conceive may wish to avoid ibuprofen.

I just found out I am pregnant, and I used ibuprofen last week for a headache. Can this cause a birth defect in my baby?

When ibuprofen is used as directed in the first and second trimester of pregnancy, it has not been associated with an overall increased risk for birth defects above the general population risk according to numerous reports. However, a few studies have suggested a possible association with the use of NSAIDs in early pregnancy and a low risk for certain birth defects.  Two studies have suggested a small increased risk for gastroschisis (a defect in which an infant’s intestines stick out of a hole in the abdominal wall) with the use of ibuprofen in the first-trimester. These studies suggest that ibuprofen use in the first-trimester raises the risk of having a baby with gastroschisis from 1 in 10,000 to between 1.6 and 4 in 10,000. However, another two studies looking at gastroschisis cases have not supported this association. Since gastroschisis is a relatively rare birth defect, the potential increased risk is very low.   A small increased risk for heart defects has been reported in three studies looking at NSAID prescriptions in early pregnancy. However, the reason the NSAID was prescribed was not available in most of the pregnancy data. This information is important because some illnesses, like viral infections, have been associated with heart defects.

At this time, there is not enough evidence to know whether ibuprofen increases the risk for heart defects or gastroschisis. However, ibuprofen is generally not the pain reliever of choice during pregnancy because there are concerns with the use of ibuprofen during the third trimester. As with any medication in pregnancy, it should only be taken as needed and with the approval of your health care provider.

I am 7 months pregnant. Can I take ibuprofen?

There is concern with the use of ibuprofen in the third trimester. The greatest concern is for premature closure of the ductus arteriosus (a vessel in the fetal heart), which can lead to high blood pressure in the fetal lungs (pulmonary hypertension). The use of ibuprofen later in pregnancy may inhibit labor or cause reduced amount of amniotic fluid (oligohydramnios). Therefore, it is recommended that women use ibuprofen only under a health care provider’s supervision during the third trimester.

I need to continue taking ibuprofen regularly throughout my pregnancy because of a medical condition. What can I expect from its use?

Studies have not found an overall increased risk for birth defects, low birth weight, or preterm labor with the use of NSAIDs in the first and second trimester of pregnancy. The concerns regarding use in the third trimester warrant close monitoring, and your doctor may follow the status of your baby’s heart and amniotic fluid volume in the third trimester by ultrasound. Additionally, you should be on the lowest dose that effectively treats your condition.

Can I take ibuprofen while I breastfeed?

The American Academy of Pediatrics has classified ibuprofen as approved for use in breastfeeding mothers. Ibuprofen enters breast milk in very low levels. One study stated that under normal dosing, the nursing infant would be exposed to less than 1mg of ibuprofen per day.

My baby’s father was taking ibuprofen regularly for backaches when I became pregnant. Will this affect my pregnancy?

There is no evidence to suggest that a father’s use of ibuprofen causes infertility or birth defects.

March 2010.  Copyright by OTIS. Reproduced by permission.

Selected References:

Bird TM, et al. 2009. Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study. J Ped Surg 44(8):1546-1551.

Briggs GG. 2002. Drug effects on the fetus and breast-fed infant. Clin Obstet Gynecol  45(1):6-20.

Conover EA. 2002. Over-the-counter products: nonprescription medications, nutraceuticals, and herbal agents. Clin Obstet Gynecol 45(1):89-97.

Dawood MY. 1993. Nonsteroidal anti-inflammatory drugs and reproduction. Am J Obstet Gynecol  169(5):1255-1265.

Ericson A and Kallen BA. 2001. Nonsteroidal anti-inflammatory drugs in early pregnancy. Reprod Toxicol 15(4):371- 375,

Hale T. 2002. Medications and Mothers Milk, 10th Ed. Amarillo, TX: Pharmasoft Publishing.

Killick S and Elstein M. 1987. Pharmacological production of luteinized unruptured follicles by prostaglandin synthetase inhibitors. Fertil Steril 47:773-7.

Janssen NM and Genta MS. 2000. The effects of immunosuppressive and anti- inflammatory medication on fertility, pregnancy, and lactation. Arch Intern Med. 160:610-619.

Li DK, et al. 2003. Exposure to non-steroidal anti-inflammatory drugs during pregnancy and risk of miscarriage: Population based cohort study. BMJ 327:368.

Nielsen GL, et al. 2001. Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs: Population based observational study and case-control study. BMJ 322: 266-270.

Nielsen GL, et al. 2004. Danish group reanalyses miscarriage in NSAID users. BMJ 328(7431):109.

Ofori B, et al. 2006. Risk of congenital anomalies in pregnant users of non- steroidal anti-inflammatory drugs: a nested case-control study. Birth Defects Res B Dev Reprod Toxicol 77(4):268-279.

Torfs CP, et al. 1996. Maternal medications and environmental exposures as risk factors for gastroschisis. Teratology 54(2):84-92.

Townsend RJ, et al. 1984. Excretion of ibuprofen into breast milk. Am J Obstet Gynecol. 149(2):184-186.

Uhler ML, et al. 2001. The effect of nonsteroidal anti-inflammatory drugs on ovulation: a prospective, randomized clinical trial. Fertil Steril 76(5):957-61.

If you have questions about the information on this fact sheet or other exposures during pregnancy, call OTIS at 1-866-626-6847.