Diclofenac in pregnancy

What is that?

Diclofenac is a type of pain reliever that your doctor can prescribe. It belongs to a class of drugs called NSAIDs (nonsteroidal anti-inflammatory drugs). This leaflet summarizes the effects of diclofenac and other NSAIDs on a baby in the womb.

The use of diclofenac during pregnancy is not advised unless prescribed by a doctor, especially if you are 30 weeks pregnant or more.

Acetaminophen is generally recommended to control pain or fever during pregnancy. If paracetamol does not control the pain, it is important to ask your doctor for advice before taking diclofenac or any other NSAID. Diclofenac can be prescribed during pregnancy to some women with certain diseases; women who need to take diclofenac after 30 weeks of pregnancy will be monitored by a specialist in fetal medicine.

What if I have already taken diclofenac during pregnancy?

Taking diclofenac before week 30 of pregnancy is unlikely to harm a baby in the womb. However, if you have taken or are taking any medicines, it is always a good idea to tell your doctor that you are pregnant so that we can decide together if you still need any medicines.

If you have taken diclofenac after week 30 of pregnancy , it is important that you tell your doctor or midwife as soon as possible.

Can taking diclofenac while pregnant cause miscarriage?

It’s not clear whether taking diclofenac in early pregnancy could increase the chance of miscarriage. Of the six studies investigating miscarriage in women taking diclofenac, three found a possible link to diclofenac use, while three did not. Some studies have also shown that women who take any type of NSAID during pregnancy are more likely to have a miscarriage than women who don’t.

Can taking diclofenac while pregnant cause my baby to be born with birth defects?

A baby’s body and most of its internal organs form during the first 12 weeks of pregnancy. It is mainly during this time that certain medications are known to cause birth defects.

Numerous studies have investigated possible links between first trimester diclofenac intake and birth defects. Current information does not raise the alarm that birth defects are caused by diclofenac use in pregnancy, although ongoing research is needed.

What problems can taking diclofenac after 30 weeks of pregnancy cause for my baby?

Premature closure of the ductus arteriosus
Before birth, a blood vessel in the baby called the ductus arteriosus must remain open to supply the baby in the womb with the mother’s nutrients and oxygen. The ductus arteriosus closes after birth. ;Premature closure of the ductus arteriosus; is the medical term used to describe this blood vessel that closes prematurely.

Taking diclofenac or another NSAID after 30 weeks of pregnancy can cause the ductus arteriosus to close while the baby is in the womb. It is important to contact your doctor or midwife immediately if you have taken an NSAID after 30 weeks of pregnancy, especially if you have taken more or more than the recommended dose.

Persistent pulmonary hypertension of the newborn (PPHN)
PPHN occurs when a newborn’s lungs don’t adapt to breathing outside the uterus. It is thought to be related, in some cases, to premature closure of the ductus arteriosus (see above). PPHN is generally rare but can be serious.

Although two small studies showed a link between PPHN and NSAID use during pregnancy, another larger study did not show a link. More research is needed to evaluate the possibility of PPHN following in utero exposure to NSAIDs and especially diclofenac.

**Oligohydramnios (reduction of fluid around the baby) **
Using diclofenac or other NSAIDs after 30 weeks of pregnancy can lead to oligohydramnios (where there is too little amniotic fluid in the sac around the baby).

Diclofenac should only be taken after the 30th week of pregnancy under medical supervision. If you took diclofenac after 30 weeks of pregnancy, your obstetrician may want to check your baby (and amniotic fluid levels) using ultrasound.

Can taking diclofenac while pregnant cause stillbirth?

One small study did not raise the alarm that diclofenac use in pregnancy causes stillbirth. Two studies of women taking NSAIDs during pregnancy also did not show a link with stillbirth.

Can taking diclofenac while pregnant cause preterm birth or is my baby small at birth (low birth weight)?

There is no evidence that the use of any NSAID in pregnancy causes premature delivery or low birth weight of the newborn.

Can taking diclofenac during pregnancy cause other health problems for the baby?

Kidney problems
There are four case reports of infants who were exposed to diclofenac in utero with kidney failure. Most of these resolved or improved rapidly after birth. However, it is also possible that the kidney problems seen in these children were due to other complications and unrelated to the use of diclofenac. More research is needed on this topic.

Learning and behavioral problems

A baby’s brain continues to develop until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on the baby’s learning or behaviour.

No scientific studies have specifically investigated whether diclofenac use during pregnancy may affect the child’s learning or behavior.

Will my baby need extra monitoring during pregnancy?

Most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects as part of their routine prenatal care. The use of diclofenac before 30 weeks of pregnancy does not normally require additional monitoring of the baby.

If you took diclofenac after 30 weeks of pregnancy, additional scans are likely needed to monitor your baby’s well-being. Discuss this with your midwife/midwife.

Are there any risks for my child if the father used diclofenac?

We would not expect any increased risk to your baby if the father used diclofenac before or around the time the baby was conceived.

Who can I talk to if I have questions?

If you have any questions about any of the information in this leaflet, please discuss them with your doctor.

Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care practitioner. It is very helpful to record all medications taken during pregnancy in portable maternity records.

Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.

She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.

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