- Dr. Kali MacIsaac
Pain in Pregnancy: Should You Rethink Popping an Ibuprofen?
At some point during pregnancy, most women will battle with pain – from headaches to muscle aches, back pain to pelvic pain, it’s incredibly common and is often a huge source of discomfort. Faced with pain, many women may consider taking something to ease it, and may turn to over-the-counter meds. Ibuprofen is one of several medications that fall under the category of over-the-conter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), and may be considered for pain relief. In fact, as many as 28% of pregnant women report the use of ibuprofen at some point during their pregnancies.
Ibuprofen is contra-indicated after the 24th week of gestation, because there have been links made to fetal malformations. We also know that ibuprofen can interfere with ovulatory function, so women who are TTC should avoid it. Another new study, suggesting ibuprofen affects male fertility, adds to the pool of evidence against its use in all people trying to conceive.
But what about early in pregnancy?
Until now, there hasn’t been much research to suggest danger of ibuprofen in early pregnancy, leading many women to consider it safe prior to 24 weeks. Also, in many cases at the very early stages of pregnancy women may take ibuprofen not knowing they’re pregnant. So researchers wanted to investigate how safe or unsafe its use may be.
This results of this study have the scientific community discussing the safety of this OTC medication. The research shows a possible link between ibuprofen in early pregnancy and changes in fetal ovarian development.
The Background You Need To Know
Female babies are born with virtually all of the egg (oocyte) cells they’ll ever have – and their initial development starts very early in utero. During the first trimester of pregnancy, the fetal ovary is undergoing dynamic development; the number of follicles that are formed during this time will represent the future reproductive capacity of the woman. A poorly stocked oocyte reserve has been shown to lead to a shortened reproductive life span, early menopause and/or infertility that only show up decades later.
Like all NSAID medications, ibuprofen works through blocking enzymes involved in the inflammatory pathway. There is existing evidence that prostaglandins and COX enzyme are involved in adult female reproductive function, but little has been known about the inflammatory enzymes’ role in ovary development.
One of these enzymes, called COX2 (cyclooxygenase 2), is involved in the initial stages of ovarian development – causing a rise in concern among the scientific community for its alteration in early pregnancy.
What The Study Showed
The researchers were curious about possible effects of ibuprofen on fetal organogenesis (organ formation) during the first trimester of pregnancy – specifically, they wanted to know if ibuprofen use by the mother could effect ovarian development of the fetus. They used an ex-vivo (outside the body) model of human fetal ovary culture, exposed it to a range of ibuprofen concentrations for various durations, and observed the results on the tissue.
First, researchers were able to show that ibuprofen crosses the placental barrier – not all medications, or even nutrients, can cross the placenta, but ibuprofen does.
Second, they showed that ibuprofen suppresses prostaglandin (PGE2) production, an inflammatory cytokine that is controlled by the COX enzymes.
Third, the researchers were able to show that with increasing ibuprofen concentrations (from 1 to 100 microM), instead of the ovarian cell number increasing exponentially (as it did in un-exposed samples), the total ovarian cell count was significantly reduced (to about -50% on average when compared to unexposed controls). The most significant decrease in cell number was shown with a 10 microM exposure for 7 days. Less, but still worrisome, decrease was shown in samples exposed to other doses (around an average of -20%).
Why This Happens
So in basic terms, this study showed that fetal ovaries contain significantly fewer oocyte cells, after exposure to ibuprofen in culture medium. But why does it happen? Researchers postulate that ibuprofen’s effects on the COX enzymes is cytotoxic, leading to apoptosis (cellular death) of developing oocytes in fetal ovaries.
The bottom line is that ibuprofen likely isn’t safe in pregnancy, at any stage.
Luckily, there are other treatments that are used very safely throughout pregnancy to help mitigate pain!
At Acubalance, our Doctors of Chinese Medicine use both acupuncture and low level laser to treat pain. Check out some of their articles about how well LLLT (low level laser therapy) works to reduce pain on our blog: here, here, and here.
If you’re currently pregnant, acupuncture points and LLLT treatment sites are adjusted to be sure the treatment will not impact your pregnancy. Be sure to let your Acubalance doc know if you are, or may be, pregnant.
If you have questions about how acupuncture and LLLT may help you, feel free to book a complimentary 15 minute consult with one of our Acubalance docs.
Dr Kali MacIsaac, HBSc ND
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