Is ibuprofen safe during pregnancy?

What does the evidence say about ibuprofen during pregnancy?

1. NSAIDs, including ibuprofen, are not recommended from 20 weeks of pregnancy onward because of the risk of low amniotic fluid and rare fetal kidney problems, per an FDA Drug Safety Communication. 1
2. Third-trimester ibuprofen use has been linked to premature closure of the fetal ductus arteriosus, a heart vessel that needs to stay open until birth. 2
3. First-trimester ibuprofen use has produced mixed findings on miscarriage and heart defects across different studies, with no single consistent link established. 2
4. Acetaminophen has long been ACOG's preferred over-the-counter pain reliever in pregnancy, with NSAIDs reserved for short-term, provider-directed use in specific situations. 3
5. Occasional low-dose use before 20 weeks is a different exposure than continuous or later-pregnancy use. The risks the FDA highlights are specific to that later window. 2

Is ibuprofen safe in each trimester?

• First trimester. Most studies haven't found a clear increase in major birth defects from first-trimester ibuprofen use, but the data on early miscarriage are mixed. Acetaminophen is the usual go-to instead when you need a pain reliever.
• Second trimester. The FDA's caution kicks in at about 20 weeks. Past that point, routine ibuprofen use isn't recommended unless your obstetric provider specifically directs it.
• Third trimester. Ibuprofen is routinely avoided in the third trimester because it can cause a key fetal heart vessel to close too early, lower amniotic fluid levels, and complicate delivery.