Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation

Anesth Analg. 2013 May;116(5):1063-1075. doi: 10.1213/ANE.0b013e31828a4b54. Epub 2013 Apr 4.


Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, which are available as "over-the counter" medications in most countries, are widely used by both pregnant and lactating women. They are popular non-opioid analgesics for the treatment of pain after vaginal and operative delivery. In addition, NSAIDs are used for tocolysis in premature labor, and low-dose aspirin has a role in the prevention of preeclampsia and recurrent miscarriage in antiphospholipid syndrome. NSAIDs and aspirin may affect fertility and increase the risk of early pregnancy loss. In the second trimester their use is considered reasonably safe, but has been associated with fetal cryptorchism. In the third trimester, NSAIDs and aspirin are usually avoided because of significant fetal risks such as renal injury, oligohydramnios, constriction of the ductus arteriosus (with potential for persistent pulmonary hypertension in the newborn), necrotizing enterocolitis, and intracranial hemorrhage. Maternal administration or ingestion of most NSAIDs results in low infant exposure via breastmilk, such that both cyclooxygenase-1 and cyclooxygenase-2 inhibitors are generally considered safe, and preferable to aspirin, when breastfeeding.

Publication types

  • Review

MeSH terms

  • Abortion, Habitual / etiology
  • Abortion, Habitual / prevention & control
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacokinetics
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antiphospholipid Syndrome / complications
  • Aspirin / adverse effects
  • Aspirin / therapeutic use
  • Breast Feeding
  • Congenital Abnormalities / epidemiology
  • Female
  • Fertilization in Vitro
  • Humans
  • Infant
  • Infant, Newborn
  • Lactation / physiology*
  • Milk, Human / metabolism
  • Pain Management
  • Pain, Postoperative / drug therapy
  • Postpartum Period
  • Pre-Eclampsia / prevention & control
  • Pregnancy
  • Pregnancy Trimester, First
  • Pregnancy Trimester, Second
  • Pregnancy Trimester, Third


  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin