Expectant moms will ask you how to treat pain or fever...in light of new FDA warnings about NSAIDs in pregnancy.
Rx labels already warn against NSAID use at 30 weeks or later in pregnancy...due to risk of premature ductus arteriosus closure.
Now FDA recommends avoiding NSAIDs at 20 weeks or later...and Rx and OTC labels will be updated.
It's due to a rare risk of NSAIDs causing fetal kidney problems, which can result in low amniotic fluid levels. This may lead to complications, such as renal dysfunction in newborns or death.
And NSAID use in the FIRST trimester is linked to miscarriage.
Generally avoid NSAIDs throughout pregnancy.
Patients may also continue to hear that acetaminophen use during pregnancy increases risk of ADHD or autism in kids.
Explain that data still only suggest an ASSOCIATION...there's NO PROOF that acetaminophen exposure causes behavioral problems in kids.
For aches and pains, continue to start with nondrug measures...such as hot or cold packs, physical therapy, or stretching.
It's okay to consider OTC topicals with menthol (Vanishing Scent Bengay Gel, etc) or lidocaine (Icy Hot Lidocaine Cream, etc) as an option for muscle aches.
But check labels closely...and steer away from topical salicylates (Ultra Strength Bengay Cream, etc) or topical NSAIDs (OTC Voltaren Arthritis Pain gel, etc).
Topical NSAIDs generally have much lower systemic absorption compared to oral NSAIDs...but still might increase risks in pregnancy.
Continue to recommend acetaminophen if needed for mild to moderate pain or a fever. It's likely safer than other oral pain meds, and a fever over 102°F during pregnancy can be risky to the fetus.
Feel comfortable if you see aspirin 81 mg/day used to decrease risk of preeclampsia and low birth weight in patients with prior preeclampsia or other risks...chronic hypertension, diabetes, etc.
If OTCs aren't enough for pain, opioids are often considered next. Emphasize using the lowest dose for the shortest duration.
Find more recommendations in our updated chart, Analgesics in Pregnancy and Lactation.
- www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic (11-16-20)
- BJOG 2019;126(4):e114-e124
- Pain Pract 2019;19(8):875-99
- Briggs GG, Freeman RK, Towers CV, Forinash AB. Drugs in Pregnancy and Lactation. 11th ed. Philadelphia, PA: Wolters Kluwer, 2017