As we enter flu season, it may be tempting to reach for ibuprofen – or a cold medication that contains it – to quell a sinus headache or muscle pains.
However, taking ibuprofen, aspirin, and other types of nonsteroidal anti-inflammatory drugs (NSAIDs) in the second half of pregnancy can lead to oligohydramnios (low amniotic fluid) or kidney problems in the baby.
The U.S. Food and Drug Administration (FDA) issued a warning this month that NSAID use between 20 weeks of pregnancy and delivery is not recommended. The previous recommendation applied only to the third trimester.
This is not new information. Rather, it is a timely reminder as influenza begins to circulate and COVID-19 continues to spread. In 2017, 35 cases of oligohydramnios or kidney problems related to NSAID use were reported to the FDA. All cases were deemed serious, and five of the newborns died.
NSAIDs can be purchased alone but are also found in multi-symptom formulas, which makes it easy to accidentally take an NSAID without realizing it.
While low-dose aspirin (81mg) for certain pregnancy conditions is advisable, patients should generally avoid taking regular strength or higher NSAIDs during pregnancy.
Why NSAIDs are problematic during pregnancy
NSAIDs block the production of prostaglandins in the body. These chemicals help reduce inflammation, which is the body's natural defense to infection or injury – and partly responsible for cold and flu symptoms such as congestion, headache, and body aches. Prostaglandins also regulate blood flow in blood vessels.
When taken during pregnancy, NSAIDs reduce blood flow to the baby's kidneys and other important structures. Reduced blood flow to the kidneys leads to reduced urine production by the fetus. Since amniotic fluid is really just the collection of fetal urine, oligohydramnios can develop. These drugs can trigger a reaction that closes an important cardiac blood vessel early, putting the fetus at risk.
While some situations, such as potentially delaying preeclampsia, require the use of NSAIDs, the risks generally outweigh the benefits during pregnancy. Thankfully, there are alternatives to help you manage cold and flu symptoms.
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This fall we’re bracing for a flu season like no other due to added concerns about COVID-19. Dr. Julie Trivedi, Medical Director of UT Southwestern’s infection prevention efforts, and Dr. Paul Sue, a pediatric infectious diseases specialist, size up the looming “perfect storm” and offer practical advice to stay safe.
What patients need to know and when
Concerns about NSAIDs include prescription and over-the-counter medications. Problems with the amniotic fluid or kidneys typically arise within days to weeks after NSAID treatment. However, amniotic fluid levels may decrease within 48 hours.
Complications of low amniotic fluid can include poor lung development or limb contracture, which means the limbs and joints are inflexible, if it happens early in pregnancy and isn’t reversible.
Low amniotic fluid often is reversible if the patient stops taking NSAIDs as soon as a problem is noticed. Rarely, babies born with kidney complications may require dialysis.
When might NSAIDs be necessary?
In rare cases, the benefits of NSAID treatment may outweigh the risks during weeks 20 and 30 of pregnancy. For example, some women may be prescribed low-dose aspirin to prevent or delay preeclampsia in patients with high blood pressure, a history of preeclampsia, or those carrying twins or more. Some Ob/Gyns may recommend it to potentially prevent early pregnancy loss or preterm birth.
These patients should take the lowest effective dose for the shortest amount of time. Doctors should avoid prescribing NSAIDs after 30 weeks' gestation. If you must take NSAIDs after 20 weeks, your doctor might recommend ultrasound monitoring to keep an eye on the amniotic fluid levels.
The FDA's MedWatch Online Voluntary Reporting Form is available for individuals to report serious symptoms or side effects related to medications. To report a concern, you may fill out FDA's online form.
Related reading: Preeclampsia can strike suddenly during pregnancy
While NSAIDs are effective, there are safer options during pregnancy.
For body aches and headaches, reach for acetaminophen, such as Tylenol, instead of aspirin or ibuprofen. Acetaminophen targets pain rather than inflammation. For cold and flu-related aches and pains, rest is the best remedy.
Stress can also cause headaches. Try taking a nap, meditating, gently exercising, or applying a cold rag to your forehead. If low-back pain plagues you, talk with your Ob/Gyn about trying physical therapy or adjusting your ergonomics to accommodate your shifting body weight.
For cough and congestion, we typically recommend that pregnant patients choose single-symptom medications instead of multi-symptom formulas. Separate medications for individual symptoms means fewer drugs added to the mix – and less risk of taking an NSAID by mistake.
You might try the cough suppressant dextromethorphan or the expectorant guaifenesin to ease your symptoms.
Related reading: Which over-the-counter cold medications are safe during pregnancy?
The FDA offers an email alert system for consumer notifications about drug safety, supplements, and specific conditions.
According to the FDA, drug labels and doctors' prescribing information will change to better indicate the risks of taking NSAIDs during pregnancy. Currently, drug labels state that NSAIDs should be avoided in the last three months of pregnancy and women should discuss use while pregnant or breastfeeding.
In the meantime, call your Ob/Gyn's office before taking ibuprofen, aspirin, or any other NSAID. The health of you and your baby are important to us, and we’re always here to help you make the best choices for your pregnancy.