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Pain Killers in Pregnancy

By Jennifer Lemoine, DNP, APRN, NNP-BC

Pain Killers in Pregnancy

Opioids and pain killers can be addictive for you and your baby.

Can you take pain killers in pregnancy? Nearly all moms question whether it’s safe to take medication during pregnancy: “Can I continue to take my allergy medication? Should I take medication if I experience nausea and vomiting during the first trimester?”

9 out of 10 moms take some type of prescription or over-the-counter medicine while pregnant. While many are safe for both you and your baby, some can create serious problems or harms. With more women than ever before using opioid pain killers, there are more pregnant women than ever before potentially using these drugs—and they’re not without problems for you or your baby. Opioids are the most commonly abused prescription drugs.

Opioid pain relievers (analgesics) include codeine and hydrocodone—you may know them as Vicodin®. Morphine is also an opioid, as is oxycodone, also known as OxyContin® or Percocet®. The most commonly used opioid however is heroin. Opioids are also found in some cough syrups, are prescribed for pain and often provided to women after surgery or dental procedures. Maybe you have received a prescription for opioid painkillers for short-term or ongoing pain.

If you were abusing opioid pain killers before you got pregnant, talk to your care provider to learn if you can get treatment for your addiction during pregnancy.  The typical treatment is to use other drugs such as methadone or buprenorphine. These drugs help you stop using opioids until you can quit them. Never quit suddenly on your own, especially if you’re pregnant as this could also cause problems for your baby, including death.


Opioids in Pregnancy

Experts think opioids for a very short-time use in pregnancy are probably ok and don’t cause any long-term problems for you or your baby. For example, if you have a tooth removed, and you take an opioid medication for two to three days, you’ll likely be fine.

Problems begin to arise if you need to take one of these medications for weeks or months—or take them in increasing doses. Opioids can increase your risks for miscarriage or preterm labor or birth and puts your baby at risk for defects, including heart and spinal problems. Even if your healthcare provider has prescribed these medications, take only take the recommended dose for the shortest period of time.


Side Effects of Pain Killers for You and Baby

Opioids affect your body in many ways; some of the most common side effects include drowsiness, nausea and vomiting, and constipation. Longer term use of these drugs can cause sleep apnea, in which your body stops breathing for short periods of time during sleep. Opioid pain killers can also create:

  • Irregular breathing
  • Tolerance, so that you need stronger doses to get the same pain relief
  • Addiction—where you physically crave and need to take the drugs
  • Withdrawal symptoms

In pregnancy, research shows opioid pain killers can cause:

  • Stomach cramps
  • Uterine contractions
  • Miscarriage
  • Problems with the placenta
  • Less oxygen flow to baby
  • Fetal growth restriction
  • Low birth weight
  • Preterm labor and preterm birth
  • Baby passing its first stool while still in your womb (meconium)
  • Stillbirth (baby’s death in your womb from age 20 weeks on)

Pain Killers & Your Developing Baby

As with any medication, opioid use during pregnancy can affect your baby. Using these pain killers early in pregnancy has been shown to increase your chances of your baby having spina bifida, a serious birth defect of the spine, and other birth defects including heart defects, hydrocephaly (fluid in the brain), glaucoma (eye problems), and cleft lip and palate, say experts at the CDC.

Just as you experience withdrawal symptoms when you stop taking pain killers, so do babies. In babies, this is called “neonatal abstinence syndrome,” (NAS), which is a big medical phrase that basically means baby has stopped using narcotics.

Babies also go through withdrawal if their moms use other drugs including heroin, methadone and buprenorphine when stepping down from stronger opioids. These medications can also lead to NAS in your baby.

If you have been using opioids before pregnancy, and continue to use them in pregnancy, your baby is likely to have NAS at birth. The longer you have taken opioids, the greater baby’s risk is for NAS. Almost all infants who have been exposed to opioids for greater than a few weeks will be born with some of the symptoms of NAS. This puts your baby at risk for breathing problems and most likely your baby will need high-level medical care in the neonatal intensive care unit (NICU).

Baby’s withdrawal symptoms will peak anywhere from 72-96 hours after birth; the severity of the baby’s withdrawal symptoms are typically related to the strength and amount of the pain killer used, as well as the last time mom took a dose before baby was born.

Withdrawing from Opioid Use

It’s not easy to quit opioids, and you may crave the drugs for years after you’ve stopped using them. According to the experts at the American College of Obstetricians and Gynecologists (ACOG) withdrawal symptoms from short-acting opioids, such as heroin, typically develop within 4–6 hours of use, and may progress up to 72 hours, and then subside within a week. For longer-acting opioids, such as methadone, withdrawal symptoms usually begin within 24 hours after last use and may last for several weeks. Even after quitting, obsessive thinking and drug cravings may persist for years, putting you at risk to start using pain killers again, ACOG cautions.


Opioid Withdrawal Symptoms in Babies

  • Excessive signs of hunger, including sucking
  • Problems breastfeeding or bottle-feeding
  • Irritability, jitters, tremors
  • Fever
  • Problems sleeping
  • Excessive crying, high-pitched cry
  • Vomiting
  • Diarrhea
  • Slow or no weight gain
  • Excessive sweating
  • Mottling (lacy appearance)
  • Faster breathing
  • Nasal congestion
  • Sneezing
  • Hiccupping
  • Hyperactive reflexes
  • Seizures


How Do I Know What Medication is Safe in Pregnancy?

Typically, if you’re pregnancy care provider has prescribed a particular medication for you, it’s considered safe for your pregnancy—but don’t just take our word for it—ask your provider why the medicine is considered safe, and how it may affect your pregnancy, if at all. Always take medications exactly as instructed on the label. If you need to take opioid medications in pregnancy, talk to your care provider to make the best choices and decisions possible for you and your baby.

Breastfeeding & Opioid Use

Plan to breastfeed your baby even if you’re using opioids or undergoing opioid treatment with methadone, say the experts at ACOG. This is true if you don’t have HIV or any other reasons that you shouldn’t nurse your baby. Minimal levels of the drugs will pass through to baby in your milk but the benefits of nursing and of breastmilk outweigh the risks. For example, the closeness and swaddling that comes with breastfeeding may even reduce neonatal abstinence syndrome symptoms in your baby. Nursing helps you and baby bond and baby receives additional immunity from you in your milk during those important first months of life.

Ask your nurses about the challenges you may face nursing your baby. Babies with neonatal abstinence syndrome may struggle to coordinate sucking and swallowing, frustrating your baby while feeding, and making baby irritable. Don’t be surprised if baby cries uncontrollably. Withdrawal symptoms can begin anytime in the first 2 weeks of life but usually start within 72 hours of birth. Symptoms may last for days or weeks.

Your labor and birth nurses, and lactation consultants who specialize in helping mothers breastfeed, are ready to help you begin breastfeeding your newborn right from birth. They can help guide you through any nursing challenges. Many hospitals and birthing centers also have a phone number—sometimes called a “warm line” you can reach night or day for advice and support. Ask your nurse for these resources before you go home with baby.

Your baby’s healthcare provider may recommend treatment during your baby’s withdrawal if baby has NAS. You’ll know your baby is doing well when he or she is able to nurse, sleep for longer periods of time like babies who don’t have NAS, and is regularly gaining weight.


Watch: Am I at Risk of Preterm Labor?

Jennifer Lemoine, DNP, APRN, NNP-BC, is an expert advisor to Healthy Mom&Baby.

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