Living with Chronic Pain
Pregnancy and Pain Medications
Many types of medications are not safe to take when pregnant, including various pain medications. Use of certain medications during pregnancy can cause premature birth, pregnancy loss, birth defects, and developmental delays in the child. Hormonal changes during pregnancy cause the body to process medications differently. Even some over-the-counter pain relievers can be dangerous to an unborn child. It is imperative to discuss with a physician any medications taken during pregnancy. If planning to become pregnant, discussion of any current medication regimens with a health care provider, preferably an obstetrician, is important.
Acetaminophen at the standard dosage is generally considered safe during all stages of pregnancy; however, it is important to note that studies show that daily use of acetaminophen for an extended period (28 days or longer) during the second trimester of pregnancy increases the likelihood of wheezing or asthma in the child.
Some studies show that taking NSAIDs, such as ibuprofen, aspirin, and naproxen, during the first trimester of pregnancy increases the risk of miscarriage. They should be completely avoided during the last trimester due to an increased risk of premature closure of the blood vessels in the developing baby's heart, which induces high blood pressure in the baby's lungs. NSAIDs can also reduce the level of amniotic fluid that surrounds the baby, making it more difficult for the mother to go into labor. While more research is needed to conclusively prove these medications are a direct cause of these issues, NSAIDs should never be taken during the last trimester (the last 3 months of pregnancy). If a physician approves the use of over-the-counter pain medications during pregnancy, women should take the lowest effective dose for the least amount of time possible.
Opioid use during pregnancy increases the odds of heart problems in the child. Taking pain medication during pregnancy also increases the chance of premature birth, preterm labor, and stillbirth. When a pregnant woman exposes her developing baby to opioids, the baby can be born addicted to the medication. The child will experience withdrawal [neonatal abstinence syndrome (NAS)]. The symptoms of NAS are severe; the baby may be born too small or with underdeveloped lungs.
The U.S. Food and Drug Administration (FDA) claims that during each trimester of pregnancy, approximately 6% of pregnant women in the United States are exposed to opioids. If a woman is taking an opioid and becomes pregnant, a health care professional will most likely decrease the medication slowly rather than advising the mother to abruptly stop taking it. Sudden cessation of opioids while pregnant could harm both the mother's and baby's health.
The bottom line
Research on pain medication use during pregnancy is challenging because pregnant women do not want to risk harming their unborn child to participate in experimental studies. The FDA believes that the research published in medical journals on the use of pain medications during pregnancy is too limited to make solid recommendations. Due to this uncertainty, the FDA suggests that the use of pain medications during pregnancy should be carefully discussed with a health care professional.
It is important to weigh the risks and benefits of pain medication use during pregnancy. Although taking pain medications during pregnancy is risky, certain health conditions may require their use. MotherToBaby is a non-profit organization that hosts experts in the safety of medication use during pregnancy and breastfeeding. Pregnant or breastfeeding women can obtain a referral from their obstetrician or contact the organization directly for the most up-to-date information and research regarding the safety of taking specific medications during pregnancy and breastfeeding.