Many women need to take medicines while they are pregnant. But not all medicines are safe during pregnancy. Many medicines carry risks for you, your baby, or both. Opioids, especially when misused, can cause problems for you and your baby while you are pregnant.

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your health care provider. However, opioid dependence, addiction, and overdose are still potential risks. These risks increase when these medicines are misused. Misuse means you are not taking the medicines according to your provider's instructions, you are using them to get high, or you are taking someone else's opioids.

Taking opioids during pregnancy can cause problems for you and your baby. The possible risks include

• Neonatal abstinence syndrome (NAS) - withdrawal symptoms (irritability, seizures, vomiting, diarrhea, fever, and poor feeding) in newborns
• Neural tube defects - birth defects of the brain, spine, or spinal cord
• Congenital heart defects - problems with the structure of the baby's heart
• Gastroschisis - a birth defect of the baby's abdomen, where the intestines stick outside of the body through a hole beside the belly button
• Loss of the baby, either miscarriage (before 20 weeks of pregnancy) or stillbirth (after 20 or more weeks)
• Preterm delivery - a birth before 37 weeks
• Stunted growth, leading to low birth weight

Some women need to take opioid pain medicine while they are pregnant. If your health care provider suggests that you take opioids during pregnancy, you should first discuss the risks and benefits. Then if you both decide that you need to take the opioids, you should work together to try to minimize the risks. Some of the ways to do this include

• Taking them for the shortest time possible
• Taking the lowest dose that will help you
• Carefully following your provider's instructions for taking the medicines
• Contacting your provider if you have side effects
• Going to all your follow-up appointments

The American Journal of Obstetrics and Gynecology has published a new CDC study: “Maternal Treatment with Opioid Analgesics and Risk for Birth Defects”. The findings from this article are summarized in the following text.

Main Findings from this Study

• Treatment with opioid analgesics was linked with the following birth defects:
  • Spina bifida (a type of neural tube defect)
  • Hydrocephaly (build up of fluid in the brain)
  • Glaucoma (an eye defect)
  • Gastroschisis (a defect of the abdominal wall)
  • Congenital heart defects
    • Conoventricular septal defect
    • Atrioventricular septal defect
    • Hypoplastic left heart syndrome
    • Atrial septal defect
    • Tetralogy of Fallot
    • Pulmonary valve stenosis
• Treatment with opioid analgesics just before or during early pregnancy was reported by 2% to 3% of the mothers.
• Codeine and hydrocodone were the most frequently reported medications, representing 69% of all reported opioid analgesics used.
• Commonly reported reasons for treatment with opioid analgesics during pregnancy included surgical procedures, infections, chronic diseases, and injuries.

Treatment Decisions

When making treatment decisions just before or during pregnancy, it is important that women and their doctors weigh the benefits of opioid analgesic medications along with their potential risks for birth defects, including some types of congenital heart defects, which are important contributors to infant morbidity and mortality.

The findings related to congenital heart defects were consistent with findings of previous studies showing links between the use of codeine during the first trimester and the occurrence of some heart defects. Congenital heart defects are among the most common birth defects, affecting nearly 1% of U.S. births, and are the main contributor to infant death attributable to birth defects. As mentioned earlier, previous studies have suggested that treatment with opioid analgesics might increase the risk for cleft lip and palate. However, in this study, the occurrence of cleft lip and palate did not appear to be linked with treatment with opioid analgesics.

In this study, the findings related to some of the other birth defects were observed for the first time. For example, links between the use of opioid analgesics and the occurrence of hydrocephaly, glaucoma, or gastroschisis have not been observed in previous studies and deserve further investigation.

About Opioid Analgesics and this Study

Opioid analgesics are prescription medications that commonly are used to treat severe pain. Two common opioid medications are codeine and oxycodone. Lower doses of opioids also might be included in some cough medicines. The effects of opioids on a pregnant woman and her unborn baby are not well understood. Previous studies looking at opioid analgesics and birth defects have had inconsistent findings. However, some have suggested that these medications might increase the risk for heart defects or cleft lip and palate.

For this study, researchers aimed to see if treatment with any opioid analgesic medication just before or during early pregnancy was associated with the occurrence of certain birth defects. The study used data from the National Birth Defects Prevention Study, a population-based, case-control study to understand the causes of and risk factors for major birth defects in the United States. Population-based means that the study looked at all babies with birth defects whose mothers lived in the study region, which is important to make sure that study results apply to the U.S. population in general.

If you have been taking opioids and you become pregnant, contact your health care provider. You should not stop taking the opioids on your own. If you suddenly stop taking opioids, it could cause severe health problems for you or your baby. In some cases, stopping suddenly during pregnancy may be more harmful than taking the medicines.

Many women who regularly take opioid medicines can breastfeed. It depends on which medicine you are taking. Check with your health care provider before breastfeeding.

There are some women who should not breastfeed, such as those who have HIV or take illegal drugs.

If you are pregnant and have an opioid use disorder, do not stop taking opioids suddenly. Instead, see your health care provider so you can get help. The treatment for opioid use disorder is medication-assisted therapy (MAT). MAT includes medicine and counseling:

• Medicine can reduce your cravings and withdrawal symptoms. For pregnant women, health care providers use either buprenorphine or methadone.
• Counseling, including behavioral therapies, which can help you
  • Change your attitudes and behaviors related to drug use
  • Build healthy life skills
  • Continue taking your medicine and getting prenatal care