Opioid Use During Pregnancy and Associated Risks

Opioid Use During Pregnancy and Associated Risks
Opioid Use During Pregnancy and Associated Risks

Opioid use Disorder during pregnancy can pose a number of consequences for the unborn baby.  Usage of opioids by expecting mothers, which include codeine, morphine, and oxycodone, can cause the unborn baby to experience withdrawals – especially when the mother’s intake of opioid-based medications are inconsistent and fluctuate. 

Opioid use can also cause harm to the unborn fetus and even impact the placenta function which could lead to further complications.

 

Opioid use poses a special set of concerns for those that are pregnant or expecting to be.  It’s important to understand the risks that opioid use during pregnancy can lead to and how it can affect prenatal care.

Opioid Using During Pregnancy
Opioid Using During Pregnancy

Opioid medications, which are referred to as narcotics, are sourced from the “poppy plant” and are normally found in prescription medications.  While opioids are critical to pain-management efforts, repetitive use can bring upon dependency, physical tolerance, urges/cravings, and the inability to exercise controlled use even while knowing the harmful effects it can cause (known as “opioid use disorder”). 

Due to the highly-addictive properties of opioids, frequent use can easily lead to addiction, or worse, an overdose.

Before using prescription opioids to ease pain it’s important to speak with your doctor about the risks and benefits associated to the use of such narcotics.  Your treatment goals should be clearly identified with your primary care physician.  Furthermore, inform your doctor if you’re pregnant and communicate your family planning goals.

What are the Risks of opioid use during pregnancy?

Expecting mothers using opioids are putting themselves and the fetus at risk.  The opioids used while pregnant are prone to travel through the placenta where it can lead to the central nervous system of the fetus.  While infrequent use of opioids during pregnancy don’t normally post health concerns for the fetus, opioid use close to the time of delivery could result in respiratory depression (ineffective/slow breathing).

However, there are a number of possible complications that correlate with opioid abuse during pregnancy, including:

  • Placental abruption/ Insufficiency 
  • Premature rupture of the membranes
  • Preterm labor/Premature birth
  • Fetal growth restriction
  • Preeclampsia
  • Miscarriage/Fetal death
  • Postpartum heavy bleeding
  • Inflammation of the fetal membranes

While many conditions have been tied to the usage of opioids during pregnancy it’s difficult to gauge the extent in which opioid abuse causes these complications.  Other factors can influence the rise of such conditions, including the usage of other drugs and nutritional/psychological conditions (which could be supporting/underlying causes of the abuse).

What’s Neonatal Abstinence Syndrome?

 

Neonatal Abstinence Syndrome
Neonatal Abstinence Syndrome

Neonatal abstinence syndrome, or, NAS, is a condition likely to emerge during pregnancy if the expecting mother becomes dependent on the use of opioids.

Neonatal abstinence syndrome is when the unborn baby experiences withdrawal-like symptoms from the mother’s opioid use.  Symptoms can affect the baby both before and after birth and can sometimes last for days to weeks. 

Signs and symptoms of a baby experiencing withdrawals can include:

  • Tremors
  • Diarrhea
  • Jitteriness
  • Restlessness
  • Uncoordinated reflexes that could result in poor feeding
  • Irritability
  • High-pitched crying
  • Poor sleeping habits

Such conditions may require the baby to be hospitalized, in some cases, for up to weeks (depending on the severity of symptoms).

The American College of Obstetricians and Gynecologists state that pregnancy alone isn’t enough of a reason for pregnant women to not treat chronic pain.  Even though opioid misuse disorder and neonatal abstinence syndrome are conditions in which pregnant mothers using opioids are likely to contract, pregnant women shouldn’t endure acute pain because they’re carrying but should understand the appropriate treatment during pregnancy.

Alternative Therapies while pregnant – Alt-opioid Treatments

Therapies while Pregnant
Therapies while Pregnant

If you’re experiencing chronic pain while pregnant your doctor will more than likely aim to create a pain management plan that minimizes the use of opioids.  Your doctor will more than likely share alternative therapies with you that would address the pain without the usage of opioids. 

Physical/behavioral therapy, non-opioid medications, and exercise are a few of the alternative therapies that are best recommended for pregnant women that should be avoiding high intakes of opioid-based narcotics. 

In the event opioids are prescribed during pregnancy, your doctor will more than likely suggest for you to take it for the shortest amount of time possible.

If struggling with an opioid use disorder during pregnancy your doctor should recommend and will more than likely prescribe a medication that acts as an opioid substitution.  This typically involves the conjunctional use of methadone (an opioid medication substitute) along with behavioral therapy and counseling.  This therapy, which utilizes alternative medicine and evidence-based therapies, has been clinically proven to reduce opioid withdrawal symptoms in addition to reducing relapse rates.  Furthermore, it enables the mother to strengthen their commitment to prenatal care and addiction recovery programs.

How does Opioid Use Disorder impact prenatal care?

If opioids are being used throughout pregnancy or the expecting mother struggles with an opioid use disorder, depending on the mother’s prior medical history and current state of dependency/use, the doctor may:

  • Screen you to determine if depression or other behavioral health conditions are enabling use
  • Frequently conduct tests to identify the presence (if any) of sexually transmitted infections
  • Advise the first-trimester ultrasound to determine the stage of pregnancy
  • Consult other healthcare professionals/specialists to devise a treatment plan that’s best suited for yours and the baby’s health care requirements
  • Consult and screen you for the use of other substances (such as tobacco)
  • Speak to you about a pain management treatment plan during pregnancy
  • Encourage you to consider breastfeeding. This is only advised for expecting mothers that are not only stable on their opioid substitute medication but also free of using illicit drugs.
  • Advise you to continue using the substituted medication post-birth to prevent a relapse.
  • Consult and discuss contraceptive options for post-pregnancy

Should acute pain emerge and persist during pregnancy it’s best to speak to your primary health care provider to determine which treatment options are safest. 

Opioid Use Disorder
Opioid Use Disorder

If you’re pregnant and believe that you have developed an opioid use disorder/problem you can speak to a Rehab South Florida admissions counselor at 561-815-1036 to explore your options. 

Our experienced addiction recovery team understands the complexities surrounding opioid-induced addictions and abuse.  As such, we provide individualized-focused care to protect the health of you and newborn.

Science-Driven OUD Treatments during Pregnancy

Opioid use during pregnancy can lead to various complications that could otherwise be avoided through alternative medicines.  Evidence-based treatments, including opioid-substitute medication, can help expecting mothers to manage pain at a reduced risk rate of encountering issues.  Alternative medicines such as Buprenorphine and methadone are two scientifically proven opioid substitutes that have shown to be safer and more effective in treating OUD, during pregnancy.

While it’s still possible for newborns to contract Neonatal abstinence syndrome from mothers that receive Buprenorphine and methadone, newborns are less likely to contract NAS compared to that of the mother maintaining the use of opioids.  Research on the topic, however, doesn’t support the reduction of medication doses to prevent NAS as the sudden cessation of opioid use may lead to illicit drug use which could pose greater harm to the fetus.

Clinical Guidance
Clinical Guidance

Methadone vs. Buprenorphine

A recently conducted meta-analysis concluded that expecting mothers that receive methadone as an opioid replacement medication are more likely to remain in treatment (increased retention). 

However, Buprenorphine is taken by expecting mothers resulted in:

  • A 10% decrease in the occurrence of Neonatal abstinence syndrome
  • An 8.46-day reduction in the amount of time taken to treat NAS
  • A reduced amount of Morphine needed to treat NAS (a 3.6mg reduction)

As always, patients that are expecting (or are planning to be) should consult their doctor to determine which medication is best for their case.

Is Breastfeeding safe During Treatment?

Breastfeeding among mothers struggling with opioid use disorder is not too common.  However, studies have shown a correlation between breastfeeding and reduced hospital duration visits.  It’s also shown that breastfeeding can reduce the need of morphine treatment for infants.  Unless other medical conditions are present, such as a “Maternal HIV Infection”, breastfeeding will help to alleviate symptoms of Neonatal Abstinence Syndrome in infants while improving bonding.

Treating Opioid Use Disorder during Pregnancy – Methadone & Buprenorphine

Opioids Maintenance During Pregnancy
Opioids Maintenance During Pregnancy

Since the 1970s, Methadone has been an opioid-alternative medicine used to treat pregnant women struggling with an opioid use disorder.  Methadone soon became the go-to OUD treatment medicine of choice and became the “standard level of care” by 1998.  Since, extensive studies on another alternative medicine for treating OUD; Buprenorphine, showed that it as well was another effective treatment option.  Both methadone and Buprenorphine are both recognized by the “American College of Obstetricians and Gynecologists” and the “American Society of Addiction Medicine” as being the best treatment options for pregnant women struggling with OUD.

Methadone and Buprenorphine – Benefits of Treatment during Pregnancy

Treatments involving the use of Buprenorphine and methadone help to improve newborn outcomes by:

  • Stabilizing opioid levels in the fetus which helps to reduce repeated prenatal withdrawal
  • Connecting mothers to effective treatment for various infectious diseases (i.e. HIV, HCV, HBV)
  • Reducing the likelihood of diseases being transmitted to the unborn child
  • Providing expecting mothers the opportunity to have better prenatal care
  • Focusing on and improving the long-term wellness outcomes for both the mother and child

Compared to expecting mothers that did “not” receive alt-treatment (women that maintained their use of opioids), those that “did” receive methadone or Buprenorphine birthed infants that had:

  • Lower risk of NAS
  • Less severe cases of NAS
  • Reduced treatment time
  • Improved gestational weight, age, and head circumference at birth

Prescription Opioids during Pregnancy – Get the FACTS

There are some KEY POINTS to take in to consideration when it comes to opioid use while pregnant:

  • Prescription opioids are considered to be narcotic painkillers that are typically prescribed following an injury, dental work or surgery. Codeine, morphine, and oxycodone are a few of the many classes of opioid-based medications.
  • If opioids are taken while pregnant the change of complications arising for the infant increase significantly. Premature birth and NAS are prominent effects of opioid use while carrying.
  • NAS can still be faced by the infant while using opioids during pregnancy, even if using them as prescribed by your healthcare provider.
  • If pregnant and using opioids do NOT quit taking the medication prior to speaking to your healthcare provider first. The sudden cessation of opioid use while carrying can cause withdrawals and issues for the baby.  Before quitting, first, consult your primary care physician.
  • If you’re not currently pregnant but have an active addiction to opioids, before attempting to become pregnant, use effective birth control until you’re no longer dependent on the drug.

What exactly are Prescription Opioids? 

Prescription painkillers contain a highly addictive property (opioids) and are administered for the alleviation of chronic pain, physical discomfort, and other pain-induced health conditions that require treatment.  If you’ve ever had surgery, had dental work completed or were involved in an accident you were more than likely administered prescription painkillers.  Prescription painkillers are written out by your healthcare provider when deemed necessary to treat a health condition.  In all states, a prescription is required for this class of drugs.

Below is a list of opioids along with their “brand” names.  The “brand name” is the title delegated to that drug/pill by the manufacturer:

 

  • Buprenorphine (Belbuca®, Buprenex®, Butrans®, Probuphine®)
  • Codeine
  • Fentanyl (Actiq®, Duragesic®, Sublimaze®)
  • Hydrocodone (Lorcet®, Lortab®, Norco®, Vicodin®)
  • Hydromorphone (Dalaudid®, Exalgo®)
  • Meperidine (Demerol®)
  • Methadone (Dolophine®, Methadose®)
  • Morphine (Astramorph®, Avinza®, Duramorph®, Roxanol®)
  • Oxycodone (OxyContin®, Percodan®, Percocet®)
  • Oxymorphone (Opana®)
  • Tramadol (ConZip®, Ryzolt®, Ultram®)

 

This list isn’t inclusive of ALL opioid-based medications/painkillers.  If you’re pregnant and want to determine if you’re presently using an opioid, speak to your primary care doctor.  There are actually some cough medicines that contain the opioid “codeine” which many are unaware of.  If you’re unsure if you’re taking opioid medications, gather a list of the medications you’re currently taking and share your pill-intake routine with your provider to determine if you are or not.

The illicit drug heroin is an opioid.  Other drugs, such as Fentanyl and other prescription

Opioids - The Starting Statistics
Opioids – The Starting Statistics

opioids, are manufactured and sold, illegally. 

When acquired and consumed illegally, drugs such as Fentanyl are sold from the street and often times mixed with other drugs such as cocaine and heroin which makes it an extremely danger opioid to use.  If such drugs are being used while pregnant seek professional intervention immediately.

Why are Opioids dangerous to use while pregnant?

Opioids are highly addictive in nature and quite easy to become dependent on, especially since in addition to alleviating pain for its users, the opioid releases multiple chemicals in the brain can cause a sort of euphoria; one that brings a sense of happiness and calmness.  Unfortunately, pregnant women may experience abnormal aches and pains while carrying which may prompt them to seek out illicit drugs that contain opioids or off-the-street pills.  This can cause adversary effects on the child.  Drug addiction is considered to be a mental illness.  Struggling with an addiction will affect one’s ability to exercise self-control and the user’s ability to stop “using”. 

Those that are addicted to prescription painkillers may eventually pursue to acquire them illegally and may begin to use heroin or even mix opioids with other drug types such as heroin/cocaine – a path that no expecting mother wants to travel down.

When you’re prescribed medication by your healthcare provider, he or she will inform you of what dosage to take, how often to take it, and for how long you need to take it.  If pregnancy and using prescription opioids it’s important that you take them exactly as prescribed.  Be sure to tell your provider about any other opioids or drugs that you’ve taken within the past 12 months. 

If you visit a healthcare provider that prescribes you an opioid don’t forget to inform the doctor that you’re pregnant. 

When taking prescription medications:

  • Never take more than you should. Closely adhere to the healthcare provider’s instruction on regulating intake.
  • Do not mix the medications with other drugs or alcohol
  • Refrain from taking prescription medications that are prescribed to someone else

Can opioids induce problems for the baby during pregnancy after birth?

Yes, it’s important to understand the effects that opioids can have on the mother and child, both before and after birth.  There are a number of issues that may arise during and after pregnancy, if the mother uses opioids, some including:

Miscarriage – This is when the baby dies in the womb prior to 20 weeks.

Preterm labor and premature birth – A preterm labor is when a woman goes in to labor before 37 weeks of being pregnant.  Preterm births are more likely to see birth defects and can cause more for at birth and later on in the child’s life.

Birth defects – Spina bifida and heart conditions are common birth defects stemming from the use of opioids by the mother during pregnancy.  Birth defects make changes to the function and shape of various parts in the body.  Defects can lead to issues with overall health, the developmental process of the body, and how the body functions.  The most common neural tube defect (also referred to as “NTD”) is “Spina bifida” which is a defect related to the spinal cord and/or brain.

Fetal-growth restriction – Also referred to as “growth-restricted”, this is the condition that describes a baby not gaining the proper amount of weight prior to birth.

Low birth weight (LBW) – If a newborn weighs less than 5 pounds, 8 ounces, he/she is considered to have a “Low Birth weight”.

Neonatal abstinence syndrome (NAS) – This is the condition in which the fetus is exposed to drugs/substances while in the womb prior to birth which causes the baby to experience withdrawal from the drug after being born.  NAS is most commonly caused from the use of opioids in pregnant women.  Being born to small and having respiratory/breathing problems are common symptoms that newborns experience with this condition.  Unfortunately, even if opioids are taken by the expected mother as prescribed there’s still a chance of NAS being caused in the newborn.  When speaking to your prenatal care provider, be as transparent and honest as possible about your opioid use, even if prescribed from another healthcare provider.  When being prescribed an opioid, do NOT let the prescribing doctor do-so without knowing you’re pregnant.

Is it safe for me to quit taking opioids while pregnant?

The short answer is NO.  The abrupt cessation (also referred to as “cold turkey”) of opioid use during pregnancy can lead to severe complications for both you and your child.  If currently pregnant and taking opioids do NOT quit cold turkey without first consulting your healthcare provider. 

Suddenly quitting the use of opioids during pregnancy can increase your risk of:

  • Placental abruption – This is a very serious condition where the placenta begins to separate from the uterus wall (the “womb”) prior to birth. It can separate either partially or completely.  Placental abruption can result in excessive bleeding that can become life-threatening to the mother and lead to premature birth.  The placenta matures in the uterus and supplies the baby with the food and oxygen needed to thrive through the umbilical cord.
  • Preterm labor and premature birth are possible pregnancy outcomes if heavy opioid abuse takes place
  • Baby-growth issues
  • Stillbirth – The death of the infant after 20 weeks into the pregnancy

Ultimately, to ensure a complication-free pregnancy, it’s in the best interest of the mother and child for opioids/prescription painkillers to be taken.  Should pain treatment medication be required by the mother alternative medications (such as the ones discussed in this guide) are safer alternatives that don’t post nearly as much risk compared to that of opioids.

Thank you for reading our “Opioid Use during Pregnancy” guide.