NSAIDs in Pregnancy

• Postpartum analgesia (including breastfeeding — short course)

Non-selective (or selective) COX inhibition → ↓ prostaglandins → analgesia, anti-inflammation, antipyresis.

• FDA 2020: avoid after 20 weeks (fetal renal + oligohydramnios)
• After 30 weeks: premature ductus arteriosus closure
• Ibuprofen safe short course while breastfeeding

Ibuprofen postpartum

400 mg TDS PO with food, max 1.2 g/day OTC

Diclofenac postpartum

50 mg TDS or 100 mg PR

• AbsolutePregnancy >30 weeks (ductus closure)
• AbsolutePeptic ulcer, severe HF, severe renal impairment
• Caution20–30 weeks — restrict to <48 h under specialist advice

• GI ulceration/bleeding
• Renal impairment
• Cardiovascular events
• Bronchospasm in aspirin-sensitive asthma

• • ≥20 wk: fetal renal impairment → oligohydramnios (reversible on discontinuation)
• • ≥30 wk: premature ductus arteriosus closure → PPHN

• SSRIs / anticoagulants

  Avoid

  ↑ GI bleed

• ACEi / ARB / diuretics

  Avoid

  Triple whammy AKI

• Methotrexate

  Caution

  ↑ MTX toxicity

• 💡 Paracetamol remains first-line analgesic in pregnancy
• 💡 For breastfeeding: ibuprofen preferred (lowest milk transfer)