Ibuprofen and Pregnancy

June 16, 2004 8:02 AM

IANAMDFilter: My wife is in her 25th week of pregnancy and has developed costal chondritis -- that is, her last rib on the righthand side is being displaced a little bit by her uterus, making it inflamed, swollen and very tender. It was recommended to her by an OB doctor at her clinic that she take 600mg of ibuprofen (an anti-inflammatory) every six hours for a few days, and to repeat this if the pain returned. Wanting a second opinion, another doctor at the same clinic said this would be OK for a few weeks, but that during the third trimester, ibuprofen should not be taken because it contains prostoglandin, and during the third trimester, the baby is sufficiently developed to react to the increased prostoglandin levels, which can cause one of its heart valves to shut prematurely, resulting in, well, unpleasantness. Specifically, the second doctor said that the baby was sufficiently developed to have this reaction by week 32, and recommended taking ibuprofen no later than week 28. But my wife is a nurse from a family of nurses, and still thinks that taking a course of ibuprofen even at this stage is too much of a risk because, apparently, not a lot of research has been done with fetuses and ibuprofen. So, rather than medical advice, I'd like to ask: Does anyone have any resources they'd like to recommend that we consult? The pain is intense enough to make tasks like traveling by car or picking up our 19-month-old pretty unpleasant, so we'd like to be able to take something (besides percocet) to make things more bearable, but there's something ominous-sounding about a prematurely closed heart valve. Any pointers?
posted by blueshammer to health & fitness (14 comments total)

Lots of other NSAIDs out there; do any of them not contain prostaglandin?
posted by mcwetboy at 8:16 AM on June 16, 2004

Here's a big article at emedicine. (with specifics to pregnancy for each drug)

(I had costochondritis once, not fun! Applied heat might help - I spent most of my time curled up with a heating pad - but since I know little prenatal safety, is that worse for jr.?)

Flurbiprofen (Ansaid) gets the "C - Safety for use during pregnancy has not been established." rating
posted by milovoo at 8:26 AM on June 16, 2004

15. Li B-S. Puncturing Xuanzhong for 106 cases of non-purulent costal chondritis. Int J Clin Acupuncture. 1999; 10: 77-78.
GB 39 was used to treat patients ranging in age from 19 to 60 years. Forty-one had symptoms for less than I week, 38 from 2 to 4 weeks, and the remainder for longer. The point is needled slightly upward and manipulated until the sensation reaches the costal area. At this point, pain usually stops. Either side can be used (both if pain is bilateral), alternating sides if more than I session is required. Pain stopped in 39 patients after I treatment and in another 59 after 2 to 3 treatments. There was no recurrence on follow-up (length of time not stated).
Comment: Easy to do on a quick appointment, and preferable to recommending cold or hot packs and giving assurance of eventual healing.
posted by biffa at 8:33 AM on June 16, 2004

Oops, that was dumb, I copied the wrong one, anyway, it's on that page.
posted by milovoo at 8:42 AM on June 16, 2004

Would she consider alternative medicine to relieve the pain? I'm at 34 weeks and went to see an accupunture/massage person. It has worked wonders. Would she consider this? Speaking as a wuss, the needles were not that big of deal.
posted by nramsey at 9:22 AM on June 16, 2004

I would double-check on what the second doctor said. Ibuprofen, like all NSAIDs, inhibits prostaglandin production, and does not contain any. That's how the class works. But as for whether it could be dangerous to the fetus, I have no idea -- it's just absolutely not because it's got prostaglandin in it.
posted by condour75 at 11:18 AM on June 16, 2004

Dr. Stoll offers information on non-drug treatment for Costochondritis.

I'd suggest the pregnancy yoga dvd/video, The New Method. The cover of the dvd looks contemporary, but the instruction by a woo-woo type. Feelings on that aside, and skipping anything that's uncomfortable in the video, there's some good stuff to help expand the area inside for baby (thus relieving pressure on the ribs).

If it's worse in the morning, check the mattress.
posted by Feisty at 11:23 AM on June 16, 2004

Ibuprofen is class B for the first 2 tri-mesters, but a D class in the 3rd. It does not contain prostaglandins, but is an inhibitor of.

"Theoretically, any non-steroidal anti-inflammatory drug (including ibuprofen and aspirin) may cause premature closure of the fetal ductus arteriosus (a fetal circulatory route)."
posted by Feisty at 11:31 AM on June 16, 2004

If you guys are game, you might try accupuncture.

It doesn't hurt and much to my initial disbelief, it does work.
posted by Argyle at 2:55 PM on June 16, 2004

Call me old fashioned, but if the issue is subdermal inflamation, I'd reccomend ice.

Use a cold pack, or ice cubes. Do not apply directly to the skin -- Wrap in a damp cloth (improve conduction). 20 on/20 off is pretty typical recomendation.

If you're worried about chilling the fetus, you can surround the ice pack with hot packs. Easy hot pack is 1 part nylon stocking, 3 cups rice or so. Tie on both ends. Heat in microwave. You'll probably want two. Should cost about... $3.
posted by daver at 3:40 PM on June 16, 2004

Also: if your major concern is dosage (of NSAIDs), try ice in combination with 2 or 3 ibuprofin/asprin a day. The lower dosage might alleviate some concern, and if you can keep the level of nsaid fairly constant (e.g. don't take it all at once), it should have some effect on the swelling.
posted by daver at 3:43 PM on June 16, 2004

A friend of mine had a displaced rib when she was pregnant...she visited a chiropractor and said that it worked wonders.

I don't know if that would help if your wife's rib is too sore to touch, but it might be something to look into.
posted by Badmichelle at 4:41 PM on June 16, 2004

AskMeFi: "chilling the fetus"
Sorry, but those three words together just jarred me.

And IMO, while I understand that your wife is in pain/discomfort, there is no cause for even a risk of injury to baby. DEFINITELY investigate the other options presented above that present NO risk to baby.

On the face of it, excessive NSAIDS does sound potentially harmful to baby.
posted by davidmsc at 9:23 PM on June 16, 2004

I would agree with being careful about all NSAIDs in order to protect the ductus areteriosus (in fact, indomethacin is an NSAID often given to neonates whose ductus has not closed properly in order to achieve closure). Ice or warmth (whichever works best) is ceretainly reasonable. Acetaminophen (the "cet in percocet) is generally considered safe during pregnancy and does not affect prostaglandins. This may be a case where narcotics are reasonable, if the pain is severe enough; I have seen pregnant women with kidney stones kept on morphine for months at a time, until the fetus was old enough for surgery to be safe, and both mother and baby did fine. I tend to be skeptical about alternative medicine, but feel free to try it; just be careful about taking any herbal remedies, as they may contain pharmacologically active compounds that are worse than what you are trying to avoid. Finally, remember that at 25 weeks your wife is almost at the point where many premies in the average neonatal ICU are born and survive having many drugs pumpted into them; in other words, the overall risk of drugs in pregnancy decreases greatly as you approach term (although there are exceptions, such as NSAIDs and blood thinners).
posted by TedW at 7:51 AM on June 17, 2004