Taking painkillers during pregnancy, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, may increase the risk of the child developing kidney problems later in life, a recent study has found.
Pregnant women are often advised not to take painkillers, particularly in late pregnancy, due to risks such as low amniotic fluid levels and kidney damage in the unborn child.
Findings from the study add to the evidence that the risk goes beyond the gestation period. Certain painkillers, even when taken in the first trimester, may increase the risk of the child developing chronic kidney disease (CKD) in later years.
Currently, around four in five women use painkillers during early pregnancy.
Risk Depends on Timing and Medication
A comprehensive study published in JAMA Pediatrics in late December 2024 tracked over 1 million children born in Taiwan between 2007 and 2017.
Researchers identified approximately 160,000 children whose mothers were prescribed and used at least one dose of NSAIDs during pregnancy. They examined the timing and type of NSAID used to assess its impact on CKD risk.
NSAIDs (both prescription and over-the-counter) include:
- Aspirin
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Diclofenac (Voltaren)
- Ketoprofen (Orudis)
- Indomethacin (Indocin)
- Ketorolac (Toradol)
- Mefenamic acid (Ponstel)
Exposure to indomethacin and ketorolac in the first trimester, mefenamic acid and diclofenac exposure in the second, and ibuprofen exposure in the third trimester were found to increase the risk of chronic kidney disease in children.
The researchers did not explain why these particular medications had associations during these periods of pregnancy.
After a median follow-up of almost 10 years, over 10,000 (1.6 percent) children in the study developed CKD.
The risk of CKD was slightly higher in the exposed group than in the unexposed group. Those exposed to NSAIDs in the womb were found to have a 10 percent higher chance of developing the disease than those not exposed.
Children exposed to NSAIDs before birth also had higher all-cause mortality and were more likely to have congenital anomalies of the kidneys and urinary tract.
Kidney Development in the Womb
The kidneys develop in the womb between weeks 5 and 36 of gestation. Research shows that an unhealthy maternal environment, including exposure to certain medications, can increase the risk of CKD later in life.
“NSAIDS are generally considered to be off limits during pregnancy, particularly during the third trimester,” Dr. Kecia Gaither, double board-certified in OB-GYN and maternal–fetal medicine and director of perinatal services and maternal–fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York, told The Epoch Times.
“We do not recommend taking NSAIDs without an OBGYN and possibly a Maternal Fetal Medicine specialist overseeing your care,” Dr. Shannon Scott Schellhammer, OB-GYN at Winnie Palmer Hospital for Women and Babies in Orlando, wrote in an email to The Epoch Times.
Research indicates that up to four in five pregnant women use over-the-counter pain relievers, including NSAIDs, during the first trimester.
NSAIDs block pain by reducing the levels of prostaglandins. Prostaglandins cause pain and inflammation but also play a vital role in maintaining kidney blood flow and filtration. A decrease in prostaglandin levels can cause restriction of the blood vessels in the kidneys, which may injure the kidneys.
“The biggest risk is to the fetus’s kidney development when taking long-term NSAIDs, which in turn can affect the amniotic fluid levels,” Schellhammer explained. The amniotic fluid is a clear yellow fluid that surrounds the womb and protects the baby.
Amniotic fluid is mainly composed of the baby’s urine. Therefore, if the baby’s kidneys aren’t working correctly, this fluid level can drop, leaving the baby less protected.
Schellhammer added that NSAID use later in pregnancy poses risks to the baby’s oxygen supply by affecting a vital blood vessel needed before birth.
Precautionary Measures
The potential risks associated with NSAID use are particularly concerning after 20 weeks of pregnancy, prompting the U.S. Food and Drug Administration to recommend avoiding NSAIDs beyond this point. Health care providers are advised to prescribe the lowest effective dose for the shortest duration when deemed necessary.
“A weighing of risks and benefits for NSAID use during pregnancy should be done on a case-by-case basis,” Gaither said.
There are circumstances when NSAID use during pregnancy is medically needed.
“Your doctor might order a one-time dose or a short treatment depending on your gestational age for certain medical conditions,” Schellhammer said.
“Some rare occasions that NSAIDS can be considered include suppressing uterine contractions to treat preterm labor,” Gaither added. However, she noted that this is only for short-term use and not the first line of treatment.
Additionally, NSAIDs can be considered in the treatment of polyhydramnios (excessive amniotic fluid) when it causes symptoms. “In symptomatic polyhydramnios, the maternal abdomen is so expanded as to cause respiratory discomfort. It’s generally used in combination with therapeutic amniocentesis (an amniotic fluid test),” Gaither said.
For pregnant women seeking safe pain relief alternatives, Gaither noted that acetaminophen, such as Tylenol, is generally regarded as a safe choice.
Low-dose aspirin is generally considered safe during pregnancy, with minimal risk of complications. The American College of Obstetricians and Gynecologists recommends it for pregnant women at high risk of preeclampsia, a condition that can lead to high blood pressure and preterm delivery.
Aside from medications, Schellhammer noted several alternatives, including heat, warm salt baths, massage, physical therapy, and topical lidocaine patches.