Ibuprofen during pregnancy, are there risks?

The Ibuprofen is a nonsteroidal anti – inflammatory. It is also found among analgesics and, therefore, it is indicated for the treatment of pain of mild or moderate intensity, in the treatment of inflammatory injuries of traumatic or sports origin and in cases of arthritis or dysmenorrhea.

Pain relievers are often the type of medication that people self-administer the most. In the case of ibuprofen, its use is very widespread today, being considered the king of painkillers . So much so, that the Spanish Agency for Medicines and Health Products (AEMPS) has recently recommended not to abuse its use without a prescription, given that at high doses, it is associated with an increase in cardiovascular risk.

As is well known, during pregnancy special care must be taken with the consumption of medications. The main fear of pregnant women is the risk of miscarriage . However, we must not forget that there are many other risks to the fetus. The Food and Drug Administration (FDA) has created a specific classification of drugs and divides them into five categories according to the level of risk.

– A: No apparent risks. It can be used.

– B: No apparent risks. There is no evidence of risk in humans. It is probably safe.

– C: No detectable risk. However, the existence of risk cannot be ruled out and should be avoided if there is another alternative.

– D: Demonstrated risk. There is evidence of risk and should only be used if the potential benefit to the pregnant woman outweighs the risk of its use.

– X: Contraindicated. There is evidence of harm to human fetuses and therefore the risk outweighs any benefit of the drug.

RISKS VARY DEPENDING ON THE STAGE OF PREGNANCY

Research on the effects of ibuprofen in the first and second trimesters of pregnancy is scarce and conflicting. While some studies confirm that there are no risks at this stage, others indicate that they could increase the risk of miscarriage . They even recommend dispensing with its use to women who are trying to conceive, as it could interfere with ovulation and the implantation of the embryo in the uterine wall or cause a subsequent spontaneous abortion.

While the research is confusing, doctors generally do not recommend ibuprofen for pregnant women in the first six months of gestation, and a minimal dose would be recommended if strictly necessary. According to the FDA classification, at this stage we would therefore move between risk levels C and D.

IN THE LAST TRIMESTER OF PREGNANCY, IBUPROFEN PROHIBITED

In this phase of pregnancy, ibuprofen is in category X according to the FDA, therefore, it would be totally contraindicated. In this phase, studies confirm the harm that can occur to the fetus as a result of ibuprofen consumption, beyond the risk of miscarriage. In addition to the reduction of amniotic fluid, which could harm the fetus and make delivery difficult, the most serious and proven detrimental effect is a congenital heart defect: patent ductus arteriosus.

The ductus arteriosus is a small tube that connects the aorta with the pulmonary artery. In the fetus it is normally open and just after birth or a few days later, it closes. If this duct remains open, there is an alteration between the systemic and pulmonary circulation , that is, the oxygenated blood is mixed with the blood with little oxygen. As a consequence, the body in general receives less oxygen than normal.

Although children with this heart defect may not have visible symptoms to the naked eye, some of the most common signs in those who do manifest them are difficulty breathing or have bluish skin. Later, developmental delays or heart murmurs, among other symptoms, may be detected.

THE REFERENCE SUBSTITUTE MEDICINE IS USUALLY PARACETAMOL.

Therefore, the evidence for the recommendation not to use ibuprofen during pregnancy seems clear. The reference substitute medicine is usually paracetamol . This is also found in pain relievers and also has antipyretic properties. In the case of a mainly inflammatory problem, it should be the referring physician who indicates the appropriate medication and assesses the risk that other anti-inflammatories, in addition to ibuprofen, also seem to have in pregnancy.