When I’m asked what the most challenging part of my pregnancy was, I say without hesitation: headaches.
A headache didn’t come on often, but when it did, it was so painful I could barely open my eyes or keep my head up. Any form of light was so piercing that I’d have to pull the shades down and lay in bed for hours with my eyes closed.
While I didn’t experience the same intensity of headaches before pregnancy, I knew that if I had ever gotten one then, an Advil or Motrin would often do the trick. For pregnant women however, the medicine cabinet can quickly become a tricky maze of “take this, not that.” That’s because with pregnancy comes a whole host of restrictions on medications you can take, from certain pain relievers to antidepressants.
Headaches were the most debilitating part of my pregnancy and came on strongest during the first and the start of the second trimester. In general, most pregnant women are told by their physicians that during that period of their pregnancy they can safely take acetaminophen, or Tylenol, to treat any pain conditions, including headaches. Physicians tell women that other common pain medications such as Advil and Motrin, known as nonsteroidal anti-inflammatory drugs (NSAIDs), are off-limits at any point during pregnancy. But should they be?
NSAIDs are an important class of drugs used to treat chronic conditions like arthritis. According to a study published March 2012 in the Journal of Obstetrics and Gynecology, as many as 23 percent of women in the United States report taking NSAIDs such as aspirin, ibuprofen, or naproxen during their first trimester. Although the medication is listed as a dangerous drug for pregnant women and their fetuses, mounting evidence suggests it may be safer to take during the first trimester than we think.
New research published Monday in the Canadian Medical Association Journal suggests that women who take NSAIDs during their first trimester to treat pain have no higher risk for miscarriages than women who don’t take them. The study looked at more than 65,000 women who gave birth between January 2003 and December 2009 at a hospital in Israel, more than 4,000 of whom took NSAIDs during their first trimester.
Besides one type of NSAID known as indomethacin, the researchers found that about 8 percent of the women who had taken NSAIDs had miscarriages compared to 10 percent among the group of women who did not take them.
Previous studies have found that taking NSAIDs during the first trimester hasn't lead to birth defects. Birth defects are one of many reasons why the medication has been contraindicated during pregnancy. After 30 weeks, however, studies have shown a link to both miscarriages and birth defects. There's some evidence however that taking low-dose aspirin is safe and works to prevent certain conditions like preeclampsia, but it's hard to tell what type of woman will benefit, how much women should take and for how long.
Unfortunately, the findings in studies taking a closer look at risk during the first trimester don’t necessarily prove that it’s safe to take NSAIDs during that period, or even at any point during pregnancy.
Because each woman is different, your physician is the best judgment on what's right for you.
Some women may take NSAIDs regularly before getting pregnant and are looking to continue their use, while others are just looking for a one-time fever reducer or pain reliever. There’s no clear answer for any of these scenarios, and that’s the problem.
There’s a lot we don't know about how safe certain medications are for pregnant women--even if they are contraindicated--and NSAIDs are just one example.
In general, it’s difficult to study medication effects during pregnancy. By scientific standards – and for obvious reasons -- it’s unethical to give women powerful medication and see how they or their babies will react to it. In addition, pregnancy is temporary, and pregnant women are typically such a small group of people who may be taking a certain medication. So with some medications, companies and research institutions find it may not be worth the dollars and cents to study. But for women who are told they should stop taking anxiety medication, antidepressants, or pain medication altogether while pregnant when they may not have to, it makes a big difference.
One good resource for medication safety information during pregnancy is the US Food and Drug Administration's pregnancy registries. The registries are part of ongoing studies comparing women who take medications or have vaccines during their pregnancies with those who do not.
So, is Advil or ibuprofen safe to take while pregnant? Conventional physicians may tell most of us to play it safe and stay away because the scientific evidence we have so far will tell us that how often it's used matters, and at least during the first trimester, we still just don’t know.
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