Circumstances in which a nonselective NSAID may be used during pregnancy

Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) may be used in limited circumstances during pregnancy.

Low-dose aspirin can be continued throughout pregnancy and an established role in the prevention of pre-eclampsia in people at risk. It is also used in the prevention of complications for people trying to conceive who have a high-risk antiphospholipid antibody profile (see Management summary for people with either persistent antiphospholipid (aPL) antibodies or antiphospholipid syndrome for more details)Australian Rheumatology Association, 2022.

A nonselective NSAID may be used judiciously up to 30 weeks’ gestation to treat conditions for which NSAIDs are known to be effective (eg ankylosing spondylitis, rheumatoid arthritis) if potential benefits outweigh potential harms. Data suggest there is no increased risk of congenital malformations. However, they are best avoided after 20 weeks gestation because of the risk of oligohydramnios via an effect on fetal kidney function. If use for longer than 48 hours cannot be avoided in this period, use the minimum effective dose for the shortest time possible and consider ultrasound monitoring of amniotic fluid.