Potential side effects and fetus safety are of concern for people requiring pain medications during pregnancy. A person can work with a healthcare professional to discuss suitable options.

During pregnancy, pain medications, known as analgesics, can cross the placenta in the same way as nutrients and oxygen.

Many medications can affect fetal development. For example, acetaminophen and ibuprofen are some of the most common medications people take to manage pain during the first trimester. However, these drugs have associations with adverse effects.

This article offers insight into the latest safety findings and how to choose safe pain medications during pregnancy.

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There is no universally safe pain medication for use in all stages of pregnancy. However, under the guidance of a healthcare professional, safe pain relief during pregnancy is possible.

A healthcare professional may consider any of the following over-the-counter (OTC) medications based on individual needs and stage of pregnancy:

A 2019 review reports that acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) can help treat mild to moderate pain during pregnancy.

However, a 2022 article notes that those in their third trimester of pregnancy should not take NSAIDs due to the risk of complications and adverse effects on the fetus.

Acetaminophen can cross the placental barrier. However, there does not appear to be any evidence to suggest that taking acetaminophen during pregnancy causes an increased chance of congenital conditions.

A 2021 consensus statement in Nature suggests that acetaminophen may have associations with neurodevelopmental, urogenital, and reproductive conditions if a person takes the medication at any time during pregnancy.

However, some professional groups object to the findings. A 2021 position statement by the American College of Obstetricians and Gynecologists (ACOG) states there is still no clear evidence showing a link between acetaminophen and fetal complications.

ACOG believes that several factors before 15 months of age can potentially lead to the same developmental concerns. In addition, people should always use acetaminophen — and all analgesics — with appropriate caution.

A person should consult a healthcare professional before taking acetaminophen during pregnancy. Doctors may recommend the lowest effective dose for the shortest time possible.

Common OTC NSAIDs include aspirin, ibuprofen, and naproxen.

The Food and Drug Administration (FDA) cautions against using NSAIDs past the 20-week mark of pregnancy due to a risk they may cause low amniotic fluid, a condition known as oligohydramnios.

DailyMed notes that it is particularly important for people to avoid taking aspirin, ibuprofen, and naproxen during the last 3 months of pregnancy unless a doctor specifically instructs otherwise.

A doctor may prescribe low dose aspirin for those at risk of preeclampsia, a condition that involves high blood pressure, water retention, and protein in the urine.

In severe cases, preeclampsia can impair the pregnant person’s liver function and lower levels of platelets in the blood.

The FDA does not recommend using CBD during pregnancy.

Not enough research exists to prove safety parameters, and there may be potential for CBD to contain contaminates such as pesticides, bacteria, or fungus.

A person can use topical pain relief products under a healthcare professional’s direction.

They can be safe options during pregnancy if they do not come into contact with mucosal surfaces, which may cause too much of the medication to be absorbed too quickly.

Prescription pain relief, which primarily consists of opioids, is not recommended during pregnancy unless nonopioid options have failed to help with severe pain.

Not only do opioids come with a risk for misuse and dependency, the Centers for Disease Control and Prevention (CDC) state that they have associations with unfavorable fetal and maternal outcomes, such as:

  • maternal death
  • preterm birth
  • neonatal abstinence syndrome
  • stillbirth
  • poor fetal growth
  • specific congenital disabilities

Chronic pain, which implies the presence of pain long-term, can be challenging to manage during pregnancy. However, there are options available.

ACOG notes that doctors aim to manage chronic pain without the use of opioids. Methods can include:

  • exercise
  • physical therapy
  • behavioral approaches

Doctors may treat chronic pain related to arthritis with certain drugs known as conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

Some of these, such as sulfasalazine (Azulfadine, Sulfazine) and hydroxychloroquine (Plaquenil), are considered safer to use throughout pregnancy.

Although these drugs are not pain medications, they may help arthritis pain by managing condition-related inflammation.

It is possible for a person to manage pain during pregnancy with minimal risks. A healthcare professional can determine which medication to use and for how long based on pregnancy stage, pain source, and overall health.

Due to well-documented pregnancy risks, doctors do not recommend NSAIDs such as ibuprofen and naproxen after the second trimester.