Can NSAIDs be taken by pregnant women with rheumatoid arthritis (RA)?

Updated: May 11, 2018
  • Author: Katherine K Temprano, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs) should be stopped at the beginning of a menstrual cycle when conception is planned, because these agents have been shown in animal studies to interfere with blastocyst implantation. Most traditional NSAIDs are considered category B medications but should be used with caution in pregnancy. [20]

Possible effects on the mother include prolonged gestation and labor, increased peripartum blood loss, and increased anemia. The potential adverse effects to the fetus include impaired fetal renal function with oligohydramnios and increased cutaneous and intracranial bleeding. Monitoring for oligohydramnios should be considered if the pregnant patient is on prolonged NSAID therapy.

NSAIDs are contraindicated in the third trimester, because they promote premature closure of the ductus arteriosus, leading to fetal pulmonary hypertension. Ductal constriction can occur at any gestational age; however, one study noted a dramatic increase in indomethacin-induced ductal constriction at 31 weeks’ gestation. [21]

Stopping NSAID therapy before 31 weeks’ gestational age is prudent for potentially avoiding adverse effects to the fetus. Short-acting NSAIDs (eg, ibuprofen, indomethacin, diclofenac) are preferred over long-acting agents.

Cyclooxygenase-2 (COX-2) inhibitors are generally considered category C medications and potentially share the same adverse effects as traditional NSAIDs.


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