Use of Ibuprofen during pregnancy: pros and cons of the drug

Headaches during pregnancy are a common phenomenon due to changes in hormonal levels, unstable psycho-emotional state, and the presence of a hidden disease.

Self-medication is strictly prohibited, because uncontrolled use of painkillers leads to termination of pregnancy and abnormalities in the development of the embryo.

To protect the child from the effects of “chemistry”, expectant mothers resort to folk remedies, but sometimes these measures are ineffective. You can relieve headaches during pregnancy without harming the baby by taking only those pills prescribed by your doctor.

Ibuprofen and pregnancy

You can take Ibuprofen during early pregnancy only on the recommendation of a doctor. It is believed that in the first and second trimester the medicine cannot change the normal course of fetal development, but still in the first twelve obstetric weeks, when vital organs are formed, gynecologists recommend refraining from using medicines that contain ibuprofen. After all, chemical effects on the mother’s body during this period are extremely undesirable.

In addition, there is scientific evidence that says that all NSAIDs increase the risk of miscarriage by approximately 2.4 times. And Ibuprofen belongs specifically to this category of drugs.

Thus, 4,705 cases of spontaneous abortions were studied. Of these, 352 (that is, more than 7%) are associated with the use of NSAIDs by a pregnant woman. Given this information, scientists have concluded that the use of non-steroidal anti-inflammatory pills in the first trimester significantly increases the risk of spontaneous abortion. Therefore, despite the fact that the instructions for Ibuprofen do not prohibit taking it in the early stages of pregnancy, many doctors refuse to prescribe such treatment to their patients.

How to use the medicine during pregnancy

Every woman dreams of becoming a mother.
However, during pregnancy, you need to remember that at this time she is responsible not only for herself, but also for the child. If a woman gets sick, then you need to be sure that the treatment method used will not harm either her or the baby. Ibuprofen is a medicine known to be effective. But to what extent will taking it be harmless for the child?

Unfortunately, during pregnancy, the mother's body sharply reduces its immunity. This is done so that the fetus is not perceived as a foreign body and does not cause rejection. However, this greatly increases the vulnerability of the mother's body. It is unlikely that you can live through your entire pregnancy and not get sick at all during this time. It is important to note that it is Ibuprofen that can be beneficial in treatment during this difficult period of life. It can be useful in the treatment of radiculitis, bursitis, gout and many other diseases. Also effective in relieving muscle or toothache. Ibuprofen is useful in treating various respiratory conditions.

Using medication during pregnancy has both positive and negative sides. If we compare Ibuprofen with aspirin, it will be safer for the body of a pregnant woman.

Scientific studies have been repeatedly conducted to study the effect of the drug in question. It was found that there is no direct effect on the fetus' body when consumed.

When comparing it with aspirin, when using it, it is necessary to take into account that the second of them is a coagulant, while the first is not. This is important for a pregnant woman. When using the drug, bleeding cannot be caused. This means that there is no threat of miscarriage.

It is important to emphasize that the use of Ibuprofen should only occur as directed by a doctor.
When taking it on your own, you may not take into account certain circumstances that may be important. Unfortunately, along with the positive features, ibuprofen also has certain disadvantages:

1. In some cases, its use can lead to blocking certain hormonal processes that play an important role in fetal ripening.
2. Another feature is that the contraction of the uterine muscles is inhibited.
3. Sometimes the ductus botallus may close, which will disrupt the development of the child in the womb.
4. In some cases, the use of ibuprofen impairs blood flow in the baby's vessels.

Although we are talking specifically about pregnancy, we note that during lactation the use of the medicine in question is completely safe.
Ibuprofen does not have any effect on the quality of a nursing mother's milk. Possible side effects of the drug in question:

1. Its use may cause temporary deafness.
2. There is a risk of depression.
3. Hallucinations may occur.
4. Shortness of breath or insomnia may occur.
5. Tachycardia.
6. Weakened vision.

It is believed that for pregnant women the daily dose cannot exceed 3200 mg (in the usual dosage this is 16 tablets).

The maximum permissible daily dose is calculated based on the patient's weight. It should not exceed 40 mg per kilogram of body weight.

FDA Safety Assessment of Ibuprofen

The FDA is the United States drug and food agency. When studying pharmaceutical products, specialists of this structure classify drugs into several categories, taking into account how dangerous they are for the unborn child.

FDA researchers classified ibuprofen as Category B. Class B can mean one of two things:

• studies on pregnant animals have been conducted and have not shown that the medicine has a negative effect on the fetus, and tests have not been conducted on pregnant animals;
• Studies on pregnant animals have shown that the drug may have a negative effect on the fetus, but testing in humans has not confirmed the risks to the fetus.

But this information only applies to taking Ibuprofen in the first two trimesters of pregnancy.

Drug research

For the third trimester, researchers classified Ibuprofen as category D, meaning it was considered dangerous to the fetus. The fact is that this drug affects the contractility of the uterus, labor and the rate of cervical ripening. While taking it, labor may begin prematurely or, conversely, the woman will carry the baby to term and then labor will have to be induced. Both situations have a negative impact on the health of mother and child.

Thus, taking the described medicine is strictly prohibited only in the last three months of pregnancy (from 29 to 40 (42) obstetric weeks).

Bottom line

Ibuprofen is clearly contraindicated after 24 weeks of pregnancy due to the well-known risk of fetal malformations. But until this date, there are no such unambiguous recommendations, as well as reliable scientific evidence of the negative effect of the drug on the unborn child. During pregnancy, paracetamol is usually the best choice for treating mild to moderate pain or fever.1 If you cannot take paracetamol, talk to your doctor about whether the benefits of taking ibuprofen outweigh the potential risks.

How to replace Ibuprofen during pregnancy

All medications containing Ibuprofen can be taken in the first two trimesters only with the permission of a doctor if the expected benefits for the expectant mother outweigh the possible risks to the fetus. If a woman has a fever or headache, she can take Paracetamol. It is considered safer for both mother and child.

Paracetamol is a worthy alternative to Ibuprofen during pregnancy

Contraindications, side effects and other important warnings from the instructions

Contraindications include the following conditions:

• individual intolerance to the components of the drug;
• hypersensitivity to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs;
• stomach and duodenal ulcers, inflammatory bowel diseases;
• blood clotting disorder;
• gastrointestinal bleeding and intracranial hemorrhage;
• severe diseases of the heart, kidneys, liver;
• infected wounds, inflammatory skin diseases (for gel);
• third trimester of pregnancy.

Ibuprofen has a long list of side effects:

• irritation of the oral mucosa, ulcers on the gums, stomatitis;
• irritation of the gastric mucosa, which can lead to heartburn, constipation, diarrhea, bloating, and abdominal pain;
• headache, nervousness, sleep problems, depression;
• difficulty breathing, bronchospasm;
• hearing and vision impairment;
• increased blood pressure and heart rhythm disturbances;
• anemia, blood clotting disorder;
• kidney inflammation, cystitis, edema;
• rash and itching on the skin, allergic rhinitis, angioedema;
• increased sweating;
• when used externally - hyperemia, tingling or itching of the skin, rash, swelling, burning sensation.

There is no need to be panicky about such a large list of negative reactions. When using Ibuprofen, the possibility of their occurrence is much lower than with other popular drugs of similar action. Research conducted in the UK suggests that if the dosage is followed, the likelihood of their occurrence is minimal.

It is important to remember that any ailment that appears in a pregnant woman can affect the health of the baby. The occurrence of at least one side effect is a reason to visit a doctor.

It is not recommended to take Ibuprofen and other drugs of similar action at the same time, as their effectiveness decreases and the risk of negative consequences increases. It is unsafe to prescribe painkillers with drugs that affect blood clotting - the likelihood of bleeding increases, as well as with alcohol-containing medications - the risk of toxic poisoning increases many times over. Ibuprofen may increase the effects of medications that lower blood sugar.

If a pregnant woman taking Ibuprofen needs another medication, the interactions between these drugs should be discussed with a doctor. The specialist will take into account all the dangers and evaluate how possible this is in each specific case.

Risk assessment

All over the world, expectant mothers use information created by the US Food and Drug Administration (FDA) to determine the risks of taking medications. The FDA has designated Ibuprofen as Category B, which means it is relatively safe during pregnancy. This means that the medication falls under one of two criteria:

• According to animal tests, no risk to the fetus has been identified, and no controlled studies have been conducted in pregnant women;
• During animal testing, side effects occurred, but clinical trials in humans did not confirm the risk to the child.

In the third trimester, Ibuprofen is assigned category D, which suggests a danger to the fetus. The use of such drugs is permissible only when the therapeutic benefit outweighs the risk.

How to take Ibuprofen during pregnancy - dosages

If necessary, pregnant women are prescribed Ibuprofen in the standard dosage intended for adults, that is, one 200 mg tablet three to four times a day or one 400 mg tablet 2 times a day. The maximum permissible daily dose should in no case exceed 1200 mg, that is, six tablets of 200 mg or 3 tablets of 400 mg.

Ibuprofen tablets should be taken after meals with water. The intervals between doses of the drug should not be less than four hours. Typically, expectant mothers are prescribed to use Ibuprofen for three to five days. In each case, the treatment regimen is drawn up individually. A woman expecting a child should not make adjustments to it on her own.

Pharmacological action of Ibuprofen

This medicine is classified as an analgesic. It has anti-inflammatory, antipyretic and analgesic effects. Due to these qualities, the scope of its application is quite wide. Examples of its use could be:

• headache;
• myalgia;
• acute respiratory diseases or flu.

In practice, this can apply to all those cases where there is severe pain or high fever. The drug will relieve these symptoms and alleviate the patient’s condition.

The medicine belongs to the group of non-steroidal anti-inflammatory drugs and is considered one of the vital medications. In particular, it is included in the relevant lists in Russia and the World Health Organization.

Ibuprofen appears to be a white crystalline powder. It is usually taken three or four times a day, two to three tablets after meals.

The drug can be used in the following forms:

1. Gel for external use.
2. Pills.
3. Suspension form.
4. Candles.

Although this medicine can be called very safe, it is not suitable for everyone:

1. Patients who have erosion or ulceration of the gastrointestinal tract should not take Ibuprofen if there is an exacerbation.
2. The risk zone includes various hematopoietic disorders.
3. If someone is intolerant to aspirin, it is not recommended that they also take ibuprofen.
4. Bronchial asthma or the presence of nasal polyps are incompatible with taking this medicine.
5. Also, this should not be done if you have various liver or kidney diseases.

As a result of taking the drug, post-maturity or premature birth may occur. Therefore, before you get carried away with taking Ibuprofen, you should ask your doctor whether you can take it during pregnancy.

Ointment and suppositories with Ibuprofen

In addition to tablets, pregnant women can use ointments and suppositories containing Ibuprofen. The ointment should be applied to inflamed joints and painful areas in a thin layer 2-3 times a day. In the third trimester, you cannot use it, just like pills.

Ibuprofen suppositories

Ibuprofen suppositories are designed for children. One suppository contains only 60 mg of active ingredient. This dosage is too small for adults, so expectant mothers are not prescribed suppositories for treatment. If no other dosage form is found, and you need to take another dose of Ibuprofen, the pregnant woman can administer two suppositories at once.

Expectant mothers can also take baby syrup if the tablets are not in the medicine cabinet.

Origin of pain syndrome

Headaches often occur in the first weeks of pregnancy. This is explained by the fact that the body’s systems are rebuilt, the volume of circulating blood increases rapidly, and the pressure rises. However, there are other reasons for the discomfort:

1. Restructuring of hormonal levels and adaptation of the body to a new state.
2. Blood pressure surges. In the first trimester, blood pressure decreases, which is associated with early toxicosis.
3. Late toxicosis (preeclampsia) is accompanied by a general deterioration in health and severe headache.
4. Incorrect, irregular or poor nutrition. Feeling hungry, eating too cold and foods containing tyramine or phenipamine (chocolate, bananas, citrus fruits, etc.) provoke headaches.
5. Mental overstrain.
6. Stress.
7. Migraine.
8. Overweight. Gaining extra pounds leads to disruptions in the functioning of important organs and systems. The woman gets tired and complains of shortness of breath. Cardiopalmus. Headache.
9. Meteor dependence.
10. Exacerbation of chronic diseases: cervical osteochondrosis, vegetative-vascular dystonia, etc.
11. Infectious lesions of the brain (meningitis, encephalitis).
12. Pathologies of the organs of vision, hearing, smell.
13. Violation of the drinking regime leads to dehydration. Metabolism and well-being are disrupted. A pronounced pain syndrome in the head appears.
14. Decreased sleep quality. Anxiety or an enlarged belly make it difficult to sleep; the expectant mother does not get enough sleep, and in the morning she suffers from a headache.

Interesting: Is it possible to take paracetamol in the 1st, 2nd, 3rd trimester of pregnancy?

Side effects of the drug

Ibuprofen is a serious drug. When taking it, pregnant women may experience the following side effects:

• nausea, vomiting;
• stomach pain, heartburn, bloating;
• allergic reactions.

In some expectant mothers, this drug causes tinnitus, insomnia, double vision, and rapid heartbeat.

Side effect of Ibuprofen - nausea

By warning about the risks to the fetus, scientists mean that Ibuprofen can cause

• miscarriages, premature births;
• pulmonary hypertension of the fetus (the active substance of the drug can provoke premature closure of the ductus arteriosus, resulting in a sharp increase in pulmonary vascular resistance);
• heart failure in the fetus.

What did the research show?

In the first trimester

Most often, pregnant women take ibuprofen in the first trimester, often simply without knowing about their pregnancy.

Fortunately, recent evidence contradicts the belief that NSAIDs increase the risk of miscarriage (and therefore preterm birth).

On the other hand, a large Norwegian study published in 2020 found that taking ibuprofen in the first trimester was associated with a small reduction in birth weight, with an average of 79 grams. However, the effect of intake in the second and third trimesters on birth weight has not been confirmed.

But recently it became known that taking ibuprofen in the first 24 weeks of pregnancy may reduce the future fertility (ability to have children) of newborn girls. The authors of a study published at the end of 2020 by one of the world's leading journals on reproductive medicine, Human Reproduction, showed for the first time that ibuprofen can be transmitted to a child through the placenta in early pregnancy. In a follow-up experiment, they also discovered that exposure to ibuprofen led to a significant loss of germ cells, which later develop into follicles that develop into female eggs. Some germ cells died, while others simply did not reproduce at normal rates.

Since girls are known to be born with all the follicles they will have for the rest of their lives, it is possible that this reduction could lead to long-term problems such as infertility or early menopause. Although the authors also emphasize that much more research needs to be done on this topic, since these negative effects were noticed very early in development, and the follicles continue to develop after the first trimester and possibly recover. The effects on a woman's fertility (early menopause or infertility) will not be seen for decades after she has been exposed to ibuprofen in utero.

In the second and third trimesters

Several studies (1996, 2011 and 2008) have shown that use of NSAIDs, including ibuprofen, in late pregnancy may be associated with severe adverse neonatal outcomes. Including increased risk:

• premature closure of the ductus arteriosus*;
• persistent pulmonary hypertension (PPH);
• congenital heart defects;
• intracranial hemorrhages;
• nephrotoxicity (drug damage to the kidneys) in the fetus;
• cleft palate...

*The ductus arteriosus must remain open while the baby is still in the uterus, and then it closes shortly after birth.
But in fact, a more dangerous condition is when the duct fails to close than its premature closure, which is clinically insignificant for most births. However, infants with some conditions still require a patent ductus arteriosus at birth to survive (for example, infants with a discordant ventricular-arterial junction, which occurs in 1 in 3,300 births).2 Taking ibuprofen or other NSAIDs in the last few weeks of pregnancy has also been associated with low blood pressure. level of amniotic fluid (amniotic fluid). Although, it appears that volume can be restored again without obvious detrimental effect on neonatal outcome after discontinuation. Doctors should regularly monitor amniotic fluid volume in women receiving NSAID treatment for a long period.

In addition, a study published in 1996 showed that exposure to NSAIDs increases the likelihood of developing persistent pulmonary hypertension in newborns (PPHN) by more than 6 times, while aspirin increases the likelihood of developing persistent pulmonary hypertension in newborns (PPHN) by more than 6 times, while aspirin increases the likelihood of developing it by almost 5 times. But in 2013, a large multicenter epidemiological study of the risks of PPHN found no evidence to support the hypothesis that maternal consumption of NSAIDs and ibuprofen in particular during pregnancy is associated with the risk of developing this disease.

Ibuprofen's inhibition of vascularization (the formation of new blood vessels) may be a cause of low birth weight and related complications. Although, as discussed above, a large 2020 study found no effect of ibuprofen in the second and third trimesters on birth weight, nor on preterm birth.3

Also, a Norwegian study published in 2013 showed a significant association between ibuprofen use in the second and third trimester with asthma in children under 18 months of age. There was no effect on infant survival, congenital malformations or structural heart defects.

In what situations should pregnant women not take Ibuprofen?

Contraindications to taking Ibuprofen are:

• third trimester;
• individual intolerance to the components included in the drug;
• stomach and duodenal ulcers;
• exacerbation of gastrointestinal diseases;
• kidney or liver damage;
• blood clotting disorder;
• optic nerve pathologies;
• history of coronary artery bypass grafting;
• bronchial asthma.

It is also not advisable for women who have been diagnosed with diabetes to take the medicine.

It is important to know that Ibuprofen should not be taken simultaneously with Aspirin, medications that reduce blood clotting.

Contraindications for use according to instructions

Despite the fact that Ibuprofen belongs to the group of NSAIDs, it should still be taken with caution, because it has a number of contraindications for use:

• erosive and ulcerative diseases of the gastrointestinal tract in the active phase;
• dysfunction of the liver and kidneys;
• hypersensitivity to the components of the drug;
• pregnancy in the third trimester;
• the presence of diseases associated with impaired hematopoiesis (anemia caused by various reasons, problems with blood clotting);
• severe heart failure.

In addition, in 2020, additional studies proved that regular use of Ibuprofen leads to an increased risk of stroke in both those suffering from cardiovascular diseases and healthy people. In this regard, the competent authorities have imposed a requirement on drug manufacturers to indicate this information on the packaging.

FDA classification

In the United States, the Food and Drug Administration (FDA) was created, which issues international product safety standard certificates to pharmaceutical companies. In addition, the FDA has developed a scale for the effects on the fetus of medications that women took during pregnancy. All drugs can be divided into 6 categories (A, B, C, D, X, N) depending on the studies performed and the degree of risk for the child.

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In particular, Ibuprofen belongs to categories B (in the first and second trimesters), and D in the third trimester.

G. G. Radnaev, Candidate of Medical Sciences, Associate Professor, Head of the Clinical Pharmacology Course of the State Budgetary Educational Institution of Higher Professional Education of the Ministry of Health and Social Development of Russia

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Category B means that tests have been conducted on animals that have not determined any negative effects on the fetus. At the same time, similar studies involving pregnant women have not been carried out. Category D means that scientists have received evidence of the risk of a negative effect of the active substance on the baby in the womb. However, if the expected benefit to the mother outweighs the risk to the child, then use is justified.

Ibuprofen in the third trimester is dangerous for a pregnant woman

About the drug

Ibuprofen is a popular non-steroidal anti-inflammatory drug. It helps:

• relieve acute pain;
• fights symptoms of pathologies of the musculoskeletal system;
• helps relieve temperature and fever.

Since the drug has a pronounced anti-inflammatory effect, it is sometimes prescribed as an alternative to antibiotics.

Compound

The active substance in the composition is ibuprofen. The drug also includes:

• microcrystalline cellulose;
• croscarmellose sodium;
• colloidal anhydrous silica;
• corn starch;
• magnesium stearate.

Release form

The drug is available in the form of tablets (200 mg). There is also a form of ointment and syrup.

Indications for use

1. Ibuprofen is often recommended for the treatment of ankylosing spondylitis, deforming osteoarthritis, and a number of rheumatoid diseases.
2. It is used as an antipyretic to relieve symptoms of fever in infectious pathologies.
3. Often the drug is indicated for pain due to migraines, after injuries, and toothache.
4. The drug is sometimes used during childbirth to relieve pain and slow down labor.

When is ibuprofen contraindicated in pregnant women?

The use of Ibuprofen is unacceptable if you have:

• individual intolerance to the components of the medication;
• aspirin-induced bronchial asthma – hypersensitivity to non-steroidal anti-inflammatory drugs, manifested by allergic rhinitis, cough and difficulty breathing;
• stomach ulcers and perforation of intestinal walls;
• severe pathologies of the cardiovascular system, liver and kidneys;
• bleeding disorders;
• eczema and purulent skin lesions - for external use.

What is better to choose: tablets, suppositories or gel?

Suppositories are considered a children's form; they contain a minimal amount of active ingredient. Sometimes they can be prescribed during pregnancy to relieve moderate discomfort, but they cannot be used to relieve severe pain and reduce high fever.

Ibuprofen gel and ointment are symptomatic remedies for relieving joint pain. Such manifestations are observed very often during the period of bearing a child due to changes in the woman’s body. There is no particular difference in the activity of these forms of the drug. They are absorbed almost equally and have the same effect on painful areas. The medicine is packaged in sealed aluminum tubes with caps. The drugs can be used for pain in the lumbar region and neck, which are associated with the development of osteochondrosis.

Tablets are considered the most effective form of medication. With a single dose, you can significantly alleviate the condition of certain pathologies. But at the same time, tablets have more contraindications and side effects. In addition, after taking them, the active substance penetrates the placenta in a larger volume, which means the risk of harm to the unborn child increases.

Ibuprofen analogues and other drugs that can replace the drug

Ibuprofen has analogues, that is, drugs with the active substance ibuprofen.

The most famous analogues of Ibuprofen - table

In addition to analogues, there are other drugs that act in a similar way. They can replace Ibuprofen if there are contraindications or allergies to the medication.

Medicines that can replace Ibuprofen - table

Analogues and drugs that have a similar effect to Ibuprofen - photo gallery

Nurofen is a drug from the UK with the active ingredient ibuprofen

Paracetamol is a pain reliever that can be used in some cases during pregnancy

The use of Panadol during pregnancy is possible in rare cases

MIG is an analgesic, anti-inflammatory, antipyretic agent, an analogue of Ibuprofen made in Germany

Faspik is a painkiller based on ibuprofen, a Swiss pharmacological class=”aligncenter” width=”599″ height=”703″[/img] Ibufen - an analogue of Ibuprofen from Poland

Burana is an NSAID that has anti-inflammatory, analgesic and antipyretic effects, a Finnish analogue of Ibuprofen

How does Ibuprofen interact with other drugs?

Since Ibuprofen is a fairly strong drug, it can negatively affect the absorption of other drugs used in parallel. To prevent such an unpleasant “neighborhood”, it is necessary to maintain an interval of at least 2 hours between medications.

Table: drug interactions

The use of Ibuprofen can negatively affect the process of ovulation and the implantation of the embryo into the uterus. This is due to the suppression of the activity of prostaglandins, which are not the least involved in fertilization.