*8.2.1 Non-steroidal anti-inflammatory drugs*

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to control symptoms in patients with rheumatic diseases. However, these drugs should be prudently used during pre-conception period and during pregnancy, as they can provoke oligohydramnios, due to reduced fetal glomerular filtration rate. In case of absolute necessity, amniotic fluid monitoring is necessary [57].

Discordant findings from large retrospective studies have shown an increased risk of miscarriage in the first trimester with the use of NSAIDs [52]. These drugs should be avoided after 32 weeks of gestation, because of the risk of premature closure of the *ductus arteriosus,* with the exception of aspirin. Indomethacin and ibuprofen appear to have much stronger ductal effects than LDA [57].

Some studies suggest that high doses of aspirin may increase the risk of fetal or neonatal bleeding or bruising in the 3rd trimester. However, these data is not robust enough to warrant conclusions. The use of selective cyclooxygenase (COX)-2 inhibitors is not recommended in pregnancy, due to the lack of safety data [52, 58].
