Is Ibuprofen Safe When Pregnant and Breastfeeding?

Summary

• Ibuprofen (Advil) is a commonly used over-the-counter (OTC) NSAID that helps with many mild-to-moderate aches and pains such as muscle aches, pain due to inflammation, headache, and fever.
• New mothers are likely to encounter some form of pain post-birth, many of which may be relieved with the use of an NSAID such as ibuprofen.
• Because many new mothers are able to breastfeed after giving birth, it is important to understand and identify the risks of breastfeeding while taking ibuprofen and other OTC medications.
• To answer this question, the drug information of Ibuprofen using UpToDate/Lexicomp is referenced.

Clinical Data

Ibuprofen is secreted in breast milk when taken by the mother [1]. However, it is important to identify how much is being secreted as well as how it compares to a standard dose of pediatric ibuprofen. For ibuprofen, the relative infant dose secreted in breastmilk is 0.6% to 0.9%. [1] In general practice, it is acceptable to use medication during breastfeeding when the relative infant dose of the medication is less than 10% of what is being excreted in the breast milk. The standard pediatric dose of ibuprofen in children 6 months to 12 years is 5-10mg/kg every 6 to 8 hours. The estimated infant dose of ibuprofen that is secreted into the breast milk and ingested by the infant is approximately 0.089mg/kg/day [1]. Overall, ibuprofen is considered safe in breastfeeding when used in standard adult doses by the mother.

When it comes to pregnancy, there are some precautions to keep in mind when the mother would like to use ibuprofen. The use of ibuprofen or other NSAIDS during times closer to conception may be associated with an increased risk of miscarriage. The mechanism of this is due to COX-2 inhibition which may interfere with implantation [1]. In a study that investigated the effects of ibuprofen and other NSAIDS on the course of pregnancy and pregnancy outcomes, it was found that there were no effects on infant survival, congenital malformation, or structural heart defects [2]. It was however found that the use of NSAIDs in the second trimester of pregnancy was significantly associated with lower birth weights. The study also found that in the second and third trimester, when an NSAID was used, the child was at a significantly increased risk for asthma at 18 months old. Overall, there are considerations to keep in mind when a pregnant woman would like to use an NSAID for pain relief during pregnancy.

Resources

1. Ibuprofen Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/plantar-fasciitis. Accessed March 31, 2021.

Nezvalová-Henriksen K, Spigset O, Nordeng H. Effects of ibuprofen, diclofenac, naproxen, and piroxicam on the course of pregnancy and pregnancy outcome: a prospective cohort study. BJOG. 2013;120(8):948-959. doi:10.1111/1471-0528.12192