Ibuprofen in pregnancy

[Michelle123]

I completed a maternity placement earlier this year, and we had a pt come in who had passed out in the shower.

She had c/o headaches, and advised that she had taken ibuprofen (actually I think it was neurofen plus - 200mg ibuprofen and 12.8mg codiene, we can get it OTC here) and her mother who was a midwife had told her it was ok to take.

I have read that it isn't good to take ibuprofen esp in the last trimester. This lady was approx 36 weeks.

The m/w who was with me, told her that they don't recommend it, and she should probably stick to paracetomal.

I was looking into the studies on iboprofen and it says that taking it in the last trimester can lead to the septal duct (?) closing prematurely in the heart which can lead to persistant pulmonary hypertension in the newborn.

I was just wondering, as the study didn't go into rates etc, but has anyone here actually seen this as a result of ibuprofen use?

And does anyone know the pathophys behind why iboprofen would cause this?

It just seems to me that if leads to this then why isn't there more of a fuss made about using ibuprofen in preg??

And how much is too much? Because this woman use it I think it was two doses (400mg each dose) when do we look at monitoring for the heart problems?

[Elvish, BSN, DNP, RN, NP]

I have a friend whose doc let her take Motrin all through her 2nd pregnancy and the baby was fine, born at term, no issues.

Recently we had a pt come in who was a pretty poor historian but said she had been taking Ibuprofen off & on for the last few weeks of the pregnancy (she was term) and baby was apparently ok.

So no, I haven't seen it happen, but I don't work in the NICU. They might see it more than we do.

[Jolie, BSN]

You are right that there is concern regarding the use of Ibuprofen late in pregnancy. Ironically, it can be effective in treating pre-term labor, but most OBs have a cut-off at which they will stop using it for this (or any other purpose) due to the risk of premature closure of the ductus arteriosus. It's been awhile since I have practiced OB nursing, but I believe that about 30 weeks is the point at which most OBs will stop its use.

As with any medication, the likelihood of adverse effects depends on dosage, frequency of use, and maybe just plain old luck. I am sure that many pregnant women have taken Motrin without problems, but as healthcare providers we are prudent to educate them about the potential risks.

BTW, one of the sickest babies I have ever seen in the NICU was a term boy who presented with respiratory failure of unknown origin (no RDS, no meconium aspiration, no pneumonia). He was so unstable that we had to hold off on a cranial U/S and cardiac echo because he simply couldn't tolerate the procedures. Finally the cardiologist insisted that he be heavily sedated so that the tests could be done. He had changes consistent with a premature closure of his ductus. I don't know if mom had taken ibuprofen or not. There was some talk about possible occupational exposure to toxic chemicals, though.

[ankagor]

the usage of Ibuprofen is forbidden in the 3rd trimester. not only it can cause a heart problems in the fetus, but also can cause preterm delivery.

the best option for pregnant is still the paracetamol (acetaminophen)

[NurseNora, BSN, RN]

We don't use it after 32 weeks because of the premature closure issue. I've never seen it happen, and I've seen many women who took Ibuprofen after 32 weeks.

I don't believe that a prostaglandin inhibitor can cause preterm delivery. In fact, we used to give it for both pain and uterine relaxation after cervical cerclage procedures done in early pregnancy.

[Michelle123]

BTW, one of the sickest babies I have ever seen in the NICU was a term boy who presented with respiratory failure of unknown origin (no RDS, no meconium aspiration, no pneumonia). He was so unstable that we had to hold off on a cranial U/S and cardiac echo because he simply couldn't tolerate the procedures. Finally the cardiologist insisted that he be heavily sedated so that the tests could be done. He had changes consistent with a premature closure of his ductus. I don't know if mom had taken ibuprofen or not. There was some talk about possible occupational exposure to toxic chemicals, though.

Do you know the outcome for the baby? The study I read didn't go into treatment methods and survival rates/disability etc unfortunately.

[Jolie, BSN]

Do you know the outcome for the baby? The study I read didn't go into treatment methods and survival rates/disability etc unfortunately.

Unfortunately, I don't. I was working my last few shifts at that hospital before moving out of state, so I don't know what the outcome was. They were considering whether to put the baby on ECMO to buy time to figure out a treatment plan, but I don't even know if that was tried. I just remember how incredibly unstable he was, in a huge, open unit, and so sensitive to noise, light, touch, everything.

[epiphany]

Nsaids are contra-indicated in pregnancy unless there special circumstances where benefits outweigh risks, such as for uterine fibroids or the use of aspirin (another anticoagulant) for clotting disorders. The only safe analgesia is tylenol. There is indeed "a fuss" about ibuprofen use - and studies done as well. There is a risk of miscarriage.

Even when used in special circumstances, it should be stopped at 32 weeks. Nsaids used for the prevention of preterm labor has to be carefully monitored and some cases, babies need to be observed closely after they are born.