1 in 7 Pregnant Women Prescribed Opioid Painkillers

1 in 7 Pregnant Women Prescribed Opioid Painkillers

About one out of every seven pregnant women in the U.S. was prescribed opioids for pain at some time during their pregnancy, according to the results of a surprising new study published in the journal Anesthesiology.

The study looked at a large database of over half a million pregnant women enrolled in an insurance plan who delivered their babies between 2005 and 2011.

Pregnant_woman2Of the more than 530,000 pregnant women, 76,742, or 14.4%, were prescribed opioids, usually for less than a week. Nearly 6% of the pregnant women were prescribed opioids in the first and second trimester. In the third trimester, 6.5% took painkillers.

The study also found the use of opioids by pregnant American women was significantly higher than in Europe.

Opioid use also varied by region, ranging between 6.5% and 26.3%, with the lowest rates in the Northeast and the highest in the South. Arkansas, Mississippi and Alabama all had opioid prescription rates in excess of 20 percent.

“Nearly all women experience some pain during pregnancy,” said study author Brian Bateman, MD, Harvard Medical School. “However, the safety of using opioids to manage their pain remains unclear. Ultimately, we need more data to assess the risk/benefit ratio of prescribing these drugs to women and how it may affect their babies.”

Back pain was the most common condition (37%) for which opioids were prescribed, according to the study. Other conditions included abdominal pain, migraine, joint pain and fibromyalgia.

The most commonly prescribed opioids during pregnancy were hydrocodone (6.8%), followed by codeine (6.1%), oxycodone (2%) and propoxyphene (1.6%).

“The risk to the fetus of short-term exposure to prescription opioids under medical supervision is difficult to assess and needs to be carefully examined in future studies,” said Pamela Flood, MD, professor of anesthesiology, Pain and Perioperative Medicine at Stanford University.

Flood says previous studies have had contradictory findings regarding the risk to the baby. An early U.S. study (1959-1965), and later studies from Sweden and Norway, did not find an association between opioid prescriptions and birth defects.

However, a U.S. National Birth Defects Prevention Study (1997-2005) found associations between codeine and other opioids with birth defects, including atrial and ventricular septal defects, hypoplastic left heart syndrome, spina bifida and gastroschisis in newborns.

The study also noted that when opioids were used long-term during pregnancy, “there is a known risk for neonatal opioid dependence and subsequent withdrawal symptoms in the first few days of life.”

“Pain occurring at some time during the course of pregnancy is common,” said Edward A. Yaghmour, MD, chair of the American Society of Anesthesiologists’ Committee on Obstetric Anesthesia.

“We need to carefully balance medications given to the mother and the risk to her and her baby. For example, we would never stop giving anti-seizure medication or medication for diabetes; the danger in those situations is clear. With opioids, there are simply not enough data to have a clear answer. Untreated severe pain in the mother may also be harmful to the fetus.”

Yaghmour says other treatments and therapies should be the first-line treatment before opioids.

Last month the American Society of Anesthesiologists urged its 52,000 members not to prescribe opioids as “first-line therapy” for any patient with chronic non-cancer pain.

Authored by: Pat Anson, Editor

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ginbug

I suffered a life changing birth injury where my hips were dislocated due to a very difficult birth. Because they did not know that this happened, my hips grew wrong and by the time docs at the shriners hosp. saw me & figured things out, I was already 5 and the damage could not be fixed. I have been in pain my whole life. My mom was told that I would most likely never be able to carry or give birth to babies because of my hips and pelvis. However I am happy to say that I was blessed w/ 2 beautiful girls; but it almost killed me! Even though I was on bed rest for both, the constant pain I felt was unlike anything I could ever have imagined; but I chose not to take anything and just suffered through it.
I do not want to tell anyone what they should or should not put into their own body; but in the case of pregnancy, it is not just your body as now their is an innocent baby that you have to consider. In my opinion, if you do not think you can handle the pain without opioids, then maybe you should not get pregnant, especially if you are already on them for chronic pain as babies born addicted to any opioids are pitiful & will most likely have long term problems. I have seen it for myself as I have 2 nephews & a niece who’s mother abused these drugs and all 3 were born addicted and all three have problems.
I think the best thing that people can do for themselves & their families is to educate themselves about not only their pain conditions & all treatments; but also about their own bodies as each one of us is different and what works for one person may not work the same for another. Doctors are human & make mistakes all the time and just because they give you something, it does not mean that it will not still do damage to you. Everyone needs to take full responsibility for themselves and especially for the choices they make!!
Remember that what docs do is called a practice for a reason!

dave

PAt- Im glad you posted this. In addition to the problems you mentioned, I have seen a study that opioids during pregnancy can cause neural tube defects. Also, I believe there is evidence that opioids during pregnancy may have long term consequences for pain modulation in the child.
Research in pain care has neglected multiobjective optimization. This is due, in part to the focus on reductionism in medicine. Researchers must be careful to consider fully the “ecology” of what they are doing. Unfortunately, in the U.S. research is a product, not of humanism, but a product of “whatever the market will bear”. And so careless neglect of multiobjective optimization in pain care research and practice will continue.