Is Voltaren gel safe during pregnancy?

What does the evidence say about Voltaren gel during pregnancy?

1. Diclofenac applied to the skin or given as eye drops reaches lower levels in the blood than the same drug taken by mouth or by injection, so less of it reaches the fetus. 1
2. A review covering more than 5,000 pregnancies found no increased chance of birth defects when NSAIDs including diclofenac were used during the first trimester. 1
3. NSAID use in the second half of pregnancy can affect fetal kidneys and the amount of amniotic fluid, and third-trimester use might cause the ductus arteriosus to close early, raising blood pressure in the fetal lungs. 1
4. FDA names diclofenac among the NSAIDs it recommends avoiding at 20 weeks of pregnancy or later, advises limiting use between 20 and 30 weeks to the lowest effective dose for the shortest duration, and advises against use after 30 weeks. 2
5. ACOG advises against NSAIDs in pregnancy unless an ob-gyn recommends them, describes a narrow second-trimester window of 48 hours or less for migraine pain acetaminophen has not helped, and names acetaminophen as the better option for pain and fever. 3

Is Voltaren gel safe in each trimester?

• First trimester. The reassuring first-trimester NSAID data comes largely from oral use, and a gel delivers less than a tablet. That is not the same as a green light. Many clinicians would rather you start with acetaminophen and save the NSAID conversation for a specific joint or nerve problem.
• Second trimester. Twenty weeks is the line FDA drew, and it applies to prescription and over-the-counter NSAIDs alike. Voltaren Gel sits on the shelf next to ordinary creams now, which makes it easy to pick up without a conversation. Ask first, especially if you would be applying it daily over a large area.
• Third trimester. FDA advises against NSAIDs entirely after 30 weeks. Later in pregnancy they can affect fetal kidneys and lower amniotic fluid, and they can cause the ductus arteriosus to close early. This is the trimester where clinicians have the least flexibility on it, topical or not.