FDA Issues New NSAIDs Warning for Second Half of Pregnancy

Damian McNamara

October 15, 2020

The US Food and Drug Administration released new warnings today that most nonsteroidal anti-inflammatory agents (NSAIDs) carry an elevated risk for kidney complications in an unborn children when taken around weeks 20 or later in pregnancy.

Citing newly available research, the agency states the risk of low amniotic fluid (known as oligohydramnios) can occur, which in turn can cause rare but serious kidney problems in the offspring. Pregnancy complications also can result.

The FDA action expands upon earlier warnings about agents in this drug class, which the FDA previously cautioned about taking after week 30 of pregnancy because of heart-related risks.

Manufacturers of both over-the-counter and prescription NSAIDs — including ibuprofen, naproxen, diclofenac, and celecoxib — will be required to update their labeling with the new warning.

Low-dose (81 mg) aspirin is excluded from this warning.

"Low-dose aspirin may be an important treatment for some women during pregnancy and should be taken under the direction of a healthcare professional," the agency states in a news release.

"It is important that women understand the benefits and risks of the medications they may take over the course of their pregnancy," Patrizia Cavazzoni, MD, acting director of FDA's Center for Drug Evaluation and Research, states in the release. "To this end, the agency is using its regulatory authority to inform women and their healthcare providers about the risks if NSAIDs are used after around 20 weeks of pregnancy and beyond."

Oligohydramnios can arise quickly — in as little as 2 days — or weeks after starting regular NSAID use in this patient population. The condition usually resolves if a pregnant woman stops taking the NSAID, the agency notes.

If a healthcare provider believes NSAIDs are necessary between about 20 and 30 weeks of pregnancy, use should be limited to the lowest effective dose and shortest duration possible, the Drug Safety Communication notes.  

As a reminder, healthcare professionals and patients should report side effects from NSAIDs to the FDA's MedWatch program.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and neurology. Follow Damian on Twitter:  @MedReporter.

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