According to the Medicines and Healthcare products Regulatory Agency, all non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided in the first two trimesters of pregnancy unless their potential benefit to the patient is greater than the risk to the growing fetus. We must remember that Ibuprofen also falls under the category of NSAIDs. Therefore, it should also be avoided in the first two trimesters unless there is some absolute indication to justify its use. The Medicines and Healthcare products Regulatory Agency also advises that NSAIDS shouldn't be used at all in the third trimester because of the harm they may cause to the fetus. Though the warning against the use of NSAIDs is clearly mentioned on the drugs' packets, it has been estimated that nearly one in every six pregnant women take them for pain relief.
Let us look at the effect of ibuprofen on the pregnancy:
- During the first trimester:
Ibuprofen and other NSAIDS, when used during the first trimester, are believed to increase the risk of miscarriage by almost 2.4 times. They may also lead to congenital birth defects like heart problems, cleft palate or defect in the abdominal wall.
- During the second trimester:
Ibuprofen may be used to provide relief from pain and inflammation if prescribed by the doctor. However, paracetamol remains the drug of choice.
- During the third trimester:
Ibuprofen consumption in the last trimester may lead to a reduction in the quantity of amniotic fluid. It may cause premature closure of ductus arteriosus and increased pulmonary pressure. It may also lead to delayed onset of labor.
According to a study published in the Canadian Medical Association Journal, taking painkillers belonging to the NSAID category before the 21st week of pregnancy can increase the risk of spontaneous abortion. The researchers involved in the study examined 4,705 women between the age group of 15 and 45 who had a miscarriage during their pregnancy. It was observed that 352 of these women had taken NSAIDs. The results were compared to another 47,050 women who had not suffered from a miscarriage despite the fact that 1,213 of them had taken NSAIDs.
The researchers found that the highest risk of miscarriage was on consuming Diclofenac. However, other NSAIDs also increased the risk of miscarriage by 2.4 times.
Let us look at the possible cause of miscarriage after taking ibuprofen. It is a known fact that prostaglandins play an important part in ovulation and implantation. They also interact with platelet activating factors and cytokines inside the fetus. NSAIDs, including ibuprofen, suppress the biosynthesis of prostaglandins. Researchers opine that a reduction in the level of prostaglandins may cause abnormal implantation of the embryo and also interfere with the platelet activating factors. This may increase the chances of miscarriage of the embryo.
Apart from the increased risk of miscarriage, consumption of ibuprofen during the first trimester of pregnancy has also been found to be associated with major congenital malformations like cleft palate and defect in the abdominal wall. In view of these side effects, the Royal College of Midwives (RCM) and Royal Pharmaceutical Society (RPS) has advised against the use of NSAIDS during pregnancy. If a pregnant woman is in desperate need of analgesia, she should only be given paracetamol.
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