Is it safe to take ibuprofen (Advil, Motrin) while pregnant?
Ibuprofen (trade names Advil, Motrin, Nuprin), is a nonsteroidal anti-inflammatory drug (NSAID) used in the treatments of fever, inflammation and pain (headache, toothache, arthritis etc.) . Like all the other NSAIDs, it is advisable to avoid using ibuprofen during pregnancy, especially in the third trimester, due to potential ill effects on the mother and baby . Other forms of the drug, such as ibuprofen gel and cream are also contraindicated.
Ibuprofen FDA Pregnancy Category 
Category C during the first 30 weeks – There is little research based evidence to establish the effects of this drug on human pregnancy during the second and third trimesters. Animal studies show adverse effects on the fetus. Recommended to consult your doctor to evaluate potential risks and benefits before taking the drug.
Category D after the 30th week – Studies carried out on human pregnancy shows increased chances of birth defects and complications when used in the third trimester.
Adverse effects of taking ibuprofen during pregnancy
It is generally believed that taking one dose of ibuprofen does not lead to any serious harm. However, recent studies suggest that even a single dosage can considerably increase your chances of miscarriage .
Use in the first and second trimesters
A study published in the Canadian Medical Association Journal (CMAJ) associates the use of an NSAID in any dosage during early pregnancy with 2.4% higher risk of miscarriage. Out of the 4,705 women studied for having a miscarriage before the 20th week, 352 (7.5%) women were exposed to some nonaspirin NSAID in the first or second trimester.
However, another study published by the same journal contradicts the above findings, dismissing any relation between the use of NSAIDs and the chances of miscarriage. The study was carried out with 65,457 pregnant women between the years 2003 and 2009, out of which, 4495 women took NSAIDs in the first trimester. Around 8.5% of the women exposed to the drug experienced a spontaneous abortion while the rate of miscarriage ranged around 10% for those who did not take it.
Ibuprofen use during the second trimester has been linked to significantly low birthweight by a study done with over 90,000 Norwegian women and their babies.
Its use in the first and second trimesters is often associated with a higher risk of congenital malformations such as cleft palate, heart defects and abdominal wall malformations . However, a study done by the CMAJ showed no association between the use of the drugs and any increase in the chances of birth defects .
Use in the third trimester (after week 30)
- Lowering the amniotic fluid levels (might lead to various complications associated with low amniotic fluid levels)
- Increasing the blood pressure in the fetal lungs 
- Affecting the fetal heart development 
- Closing the ductus arteriosus prematurely (blood vessel in the fetus that carries blood from the fetal pulmonary artery to the still-immature lungs) 
- Delaying and prolonging your labor 
In one study, children born to mothers who used ibuprofen in their second or third trimesters were shown to have a greater risk of developing asthma in early childhood.
Safer substitute for ibuprofen in pregnancy
Oral acetaminophen or paracetamol (Tylenol, Panadol), a Category B drug, is considered to be a safer alternative pain management option for pregnant women .
Ibuprofen while breastfeeding
Contraindicated for breastfeeding mothers as the drug enters breast milk and might be harmful to the nursing infant . However, the American Academy of Pediatrics (AAP) recommends ibuprofen as the preferred choice of pain medication during lactation after acetaminophen . Ibuprofen is the preferred choice out of all the NSAIDs (aspirin, naproxen) as it is excreted in the breast milk only in small amounts with well-researched data available regarding its effects on children .
- http://www.ncbi.nlm.nih.gov/pubmed/15852232 [/ref]