Diclofenac Use During Pregnancy

Introduction to Diclofenac and Pregnancy

• The American College of Rheumatology strongly recommends avoiding all NSAIDs in the third trimester 2
• Diclofenac should be avoided during pregnancy, particularly after 20 weeks of gestation, and is strictly contraindicated after 28-30 weeks due to serious fetal risks including premature closure of the ductus arteriosus and oligohydramnios 1

Recommendations by Trimester

• Diclofenac may be used with caution before 20 weeks of gestation, but only at the lowest effective dose and for the shortest possible duration (7-10 days maximum) 2, 1

Risks and Considerations

• The use of NSAIDs after 20 weeks is associated with fetal renal dysfunction, which can lead to oligohydramnios 3
• Fetal risks include premature closure of the ductus arteriosus, oligohydramnios, pulmonary hypertension, and renal dysfunction 3, 1
• Maternal risks include prolonged gestation and labor, increased bleeding, and anemia 3, 4

Breastfeeding

• Diclofenac is considered safe during breastfeeding, as it passes into breast milk in minimal amounts 5
• However, it is contraindicated in newborns with jaundice, as NSAIDs displace bilirubin 3

Alternative Therapies During Pregnancy

• Hydroxychloroquine is compatible with pregnancy 2, 1
• Sulfasalazine (with folate supplementation) is compatible 1
• Low-dose glucocorticoids (≤10 mg/day of prednisone) are compatible 2, 1
• Azathioprine and colchicine are also compatible 1

Clinical Pitfalls to Avoid

• Many pregnant women are unaware that aspirin and ibuprofen are NSAIDs and may consider them safe 3
• NSAIDs are available over-the-counter, making unsupervised self-medication easier 3

Management in Case of Exposure

• If exposure to diclofenac occurs in the third trimester, immediate cessation and fetal evaluation for ductal constriction and oligohydramnios by ultrasound are recommended 1