Pain Medications during Pregnancy
Kelsey McLaughlin, PhD
Pregnancy is associated with many changes to the mother’s body. These changes can commonly cause backaches, pains and headaches, which may require pain medication.
Keep reading to learn more about over-the-counter pain medication use during pregnancy!
Medication Use during Pregnancy
Approximately 90% of pregnant patients take at least 1 type of medication during pregnancy; this includes both prescription medication and over-the-counter medication.
Unfortunately, pregnant patients are commonly excluded from clinical trials during the development of new drugs. Drug development for pregnant patients is a challenge with few randomized controlled trials that include pregnant patients, leading to a lack of safety information for medication use during pregnancy. The majority of safety data for medication use during pregnancy comes from other sources, including case reports, case-control studies, cohort studies and observations from clinical use over time.
Common Pregnancy-Associated Pain
Pregnant patients may experience pain or discomfort in a variety of areas that are mainly due to hormonal or physical changes associated with pregnancy. These commonly include backache, headache, leg cramps, and ligament pain.
Non-pharmacologic recommendations to relieve pregnancy-associated pains include using an ice pack or heating pad, massage, stretching, yoga, meditation, and rest.
Over-the-counter medications (medication that can be purchased without a doctor’s prescription) may be recommended by your healthcare provider to provide pain relief.
Approximately two-thirds of patients use acetaminophen during pregnancy, including the first trimester.
Acetaminophen is recommended as the first choice for pregnant patients requiring pain relief. The American College of Obstetricians and Gynecologists refers to acetaminophen ‘as one of the only safe pain relievers for pregnant individuals during pregnancy'.
Under the previous Food and Drug Administration for fetal risk of medications, acetaminophen was classified as Category B, meaning that animal studies with acetaminophen show no fetal risk but there are no clinical trials in pregnant patients.
Additional research has investigated associations between Acetaminophen use during pregnancy and increased risk of attention deficit hyperactivity disorder (ADHD) in children. Two studies determined that there might be a small risk with prolonged use of acetaminophen, however, no concrete conclusions could be made.
A recent consensus statement was published calling for more research into potential effects of Acetaminophen use during pregnancy and neurological, urogenital and reproductive disorders in children. However, the American College of Obstetricians and Gynecologists responded to this statement that ‘clinical guidance remains the same and physicians should not change clinical practice until definitive prospective research is done. Most importantly, patients should not be frightened away from the many benefits of acetaminophen'.
Similar to other medications, Acetaminophen taken during pregnancy should be used only as needed, in moderation, and after the pregnant patient has consulted with their doctor.
Aspirin is not recommended for use during pregnancy.
Although the risk is low, aspirin use during the first trimester has been associated with an increased risk of gastroschisis, a birth defect of the baby’s intestines. No other birth defects were associated with aspirin use during pregnancy.
Interestingly, aspirin has been investigated as a therapy for various pregnancy complications, including preeclampsia. Aspirin therapy initiated between 11-14 weeks of pregnancy significantly reduces the risk of early preeclampsia in high-risk pregnant patients. Aspirin use throughout pregnancy was not associated with increased risk of maternal, fetal chromosomal or fetal structural abnormalities or additional adverse events, including headache, vaginal bleeding and other bleeding, was not increased with aspirin use in this population of pregnant patients.
Aspirin should therefore be avoided during pregnancy, especially early pregnancy, unless prescribed by a physician and the patient understands the risks and benefits.
Ibuprofen (Advil™️, Motrin™️) and Naproxen (Aleve™️)
Ibuprofen and Naproxen belong to a family of drugs known as non-steroidal anti-inflammatory drugs (or NSAIDs). Health Canada recommends that pregnant women do not use NSAIDs, especially after 20 weeks of pregnancy, unless advised to do so by their healthcare provider.
This is because NSAID use during pregnancy is associated with an increased risk of:
A recent investigation found that the use of NSAIDs after 20 weeks of pregnancy is associated with an increased risk of kidney problems in the baby. These kidney problems can lead to low levels of amniotic fluid and possible pregnancy complications. Although these problems are rare, can be serious.
Deciding When to Take Medication
Before pregnant patients begin taking any type of medication during pregnancy, including prescription, over-the-counter or herbal remedies, it is important that patients speak to their healthcare provider.
Healthcare providers can counsel patients regarding the safety of medications and any potential risks, especially given the limited safety data of some medications for use during pregnancy.
A good general rule of thumb is to try to avoid medication use during the first trimester if possible and use the lowest dose of medication for the shortest period possible.
Pregnant patients with certain health conditions may need to be treated with medications that are not generally recommended during pregnancy. In these situations, the risks and benefits of certain medications need to be weighed and decisions should be discussed with healthcare providers. An example of this is aspirin therapy in pregnant patients at high risk of developing preeclampsia, or NSAID therapy in pregnant patients with rheumatoid arthritis.
Pregnant patients commonly take over-the-counter pain medication to provide pain relief for pregnancy-associated aches and pains. Acetaminophen is safe and generally recommended for pain relief during pregnancy. Aspirin and NSAIDs (Advil™️, Motrin™️, Aleve™️) are typically not recommended for use during pregnancy due to increased risk of adverse fetal outcomes. Pregnant patients should always speak to their healthcare provider regarding the best choice of pain medication for them.
Every woman and every pregnancy is unique. Pregnant women should speak to their healthcare provider to ensure maternal and fetal safety. This article is meant to provide readers with current information and opinions. All medical and treatment decisions should be discussed with your healthcare provider.