CDC: Pregnant Women on Painkillers Put Babies at Risk

CDC: Pregnant Women on Painkillers Put Babies at Risk

About a third of women of childbearing age in the U.S. are taking opioid painkillers, according to a new report by the Centers for Disease Control and Prevention that warns of the dangers of opioid use during pregnancy.

CDC researchers say 39% of women aged 15-44 years of age who were enrolled in Medicaid filled a prescription for an opioid pain medication each year from 2008-2012. That compares to 28% of women with private health insurance. The report, published in this week’s Morbidity and Mortality Weekly Report (MMWR), does not address how many of the women actually became pregnant.

“Taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother,” said CDC Director Tom Frieden, MD. “Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child.”

CDC GRAPHIC

CDC GRAPHIC

Opioid prescription rates were highest among women of child-bearing age in the South and lowest in the Northeast.  White women were nearly one and a half times more likely to be on opioids than African-American or Hispanic women.

A study published last year in the journal Anesthesiology found that one out of every seven pregnant women in the U.S. were prescribed opioids at some time in their pregnancy – a rate significantly higher than women in Europe. Nearly 6% of the pregnant American women were prescribed opioids in the first and second trimester. In the third trimester, 6.5% took painkillers.

Federal health officials say opioid use during pregnancy might increase the risk of birth defects and neonatal abstinence syndrome (NAS), which can cause a newborn infant to experience symptoms of withdrawal from medications taken by a mother during pregnancy.

“Women, who are pregnant, or planning to become pregnant, should discuss with their health care professional the risks and benefits for any medication they are taking or considering.” said Coleen Boyle, PhD, Director of CDC’s National Center on Birth Defects and Developmental Disabilities. “This new information underscores the importance of responsible prescribing, especially of opioids, for women of child bearing age.”

Previous studies have had contradictory findings regarding the risk of opioids to babies. 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 heart defects, spina bifida and gastroschisis in newborns.

Authored by: Pat Anson, Editor

There are 9 comments for this article
  1. Rainey at 12:20 am

    This study raises more questions than it answers.
    How strong of a link is there between opiate use in pregnancy and birth defects?

    They classify all opiates together, but there are a lot of different medications that fall into the category. Maybe one medication (or class of medications) is responsible for the majority of cases. Do we know?

    The study includes women who took opiates a full month before conception, but it doesn’t differentiate between them and those who took opiates during the first trimester. The first trimester is a time when drug exposure can do a lot of damage: everything develops (brain, heart, skin) during this time. The month before conception doesn’t seem like it is a very relevant time: the previous cycle completes then the egg matures and is released. Maybe I am missing something.

    I believe the real purpose of the study was to scare women of childbearing age (and their providers) into avoiding opiates. I anticipate that woman of childbearing age will be asked if they are pregnant, or could be pregnant before they get their prescription for opiates.

  2. Kurt W.G. Matthies at 6:31 pm

    Thank you, Dr. Anonymous, for providing us with the original report.

    As he correctly notes, the women in this study were treated with prescribed opioids as treatment for surgery (41%), infections (34%), chronic diseases (20%), and injuries (18%). The authors note that “the most commonly reported reason for opioid use was surgical procedures, other medications, such as anesthesia, could have been used concomitantly for this or other indications.”

    They fail to explore the relationship of other medications used in the 52% of subjects with infection and injuries, and the variety of other medications used to treat the 20% of women with chronic diseases with birth defects.

    Because the study lacks controls and blatantly ignores these confounding factors, it proves nothing but the authors’ bias against opioid analgesics.

    It loathes this reader to see bad science dressed up as good medical research in the continuing effort to prevent birth defects, that serves neither pregnant women nor their unborn children.

  3. Sandy at 11:56 am

    To Marty complaining about women in pain having children. I didn’t plan on it but it happened. I understand part of your point. But you are also acting as if these medications just put your nose in the dirt instead of helping maintain normal function.

    I am certainly blessed with a loving and helpful family too. There were times I needed them and some days the fatigue is overwhelming.

    Fact remains until the US has better access to birth control and family planning, there will be high rates of unplanned pregnancies.

    Also take note of where those ‘unplanned’ pregnancies are the highest. In the South [where I currently live]. Where access to decent sex-ed, family planning and bc are least available, unplanned pregnancies and teen pregnancies are the highest.
    Maybe men should stop trying to legislate women’s reproductive health and step out of the way? Unless they are exceptional OB/GYNs which there are some great, male OBs out there. I have one now.
    We are having to write to the maker of Mirena IUDs so I can have a ‘chemical hysterectomy’ instead of the real deal to control cysts. Cost of IUD not covered by my insurance? 700$ and that is just for the IUD.
    I am almost 44. 3 kids, age 25, 21 and 11.

  4. Sandy at 11:30 am

    I am a chronic pain patient who was OK’ed for **low dose opiate therapy** during the pregnancy of my 3rd child. There was a protocol. First, notified my OB/GYN that I was a CPP and in pain management, then took the written OK to my CP doctor. The two communicated on their own after that; this was 12 years ago. Discovered my pregnancy very early on before 6wks. All other meds were discontinued until several weeks after she was born.

    My daughter was not born addicted, did not need narcan, was born normal and healthy. But again ALL OTHER MEDS were discontinued during my pregnancy and I didn’t need pain meds in the 1st trimester either [something in those hormones helped with pain and fatigue!]

    I was able to breastfeed her for the first 2-3 weeks [again, still receiving low-dose medications and supervised by peds and pain doc] but after that had to go back on gabapentin and low dose benzo for mild PTSD/Chronic anxiety [which is very common for people in chronic pain. Our nerves/central nervous system are shot to hell. Sometimes it is a side-effect of opiate therapy too]

    However, proper prenatal care in the US and especially in the South is not always available. I had it through my employer’s insurance. Though by the first month of my 3rd trimester I had to go onto work disability [which I paid into] and today, after trying to work have been approved for SSDI [not before many denials, a lawyer and appearing before a panel of Federal Judges]

    My daughter will be 12 in a couple of months, she is an exceptional reader and student. Highly intelligent with no health problems or birth defects. I do question some of the meds they put pregnant women on that are not old meds, tried and tested over 100yrs. Medications like Cymbalta should NEVER be given. Medications in that class SSRIs should be verboten during pregnancy.

  5. Doc Anonymous at 7:49 am

    The article looked at frequency of prescriptions but quotes an earlier non-CDC article for stats on birth defects. That article listed surgery, injury, infection and chronic disease as the reasons for taking opioids. Even if we look at the alternatives to opioids NSAIDs are the mainstay, unless we adopt a standard of no treatment. If you look up the Odds-Ratios for birth defects with NSAIDS, it is only slightly more favorable than opioids.

    The MMWR article points out that HALF of the pregnancies in the US are unplanned. Perhaps the overall “Best Practices” approach is to provide more birth planning information and services along with any use of opioids or NSAIDS in women of child bearing age. Perhaps treatment should also include ready access to all birth planning techniques.

    Once again, opioid bashing seems to be taking the front seat and quality MEDICAL CARE is taking a back seat. “Non-use of opioids” is no more “quality medical care” than “over-use”.

  6. Kaylee at 7:32 am

    Just because a third or reproductive aged women filled a prescription for opioid medication in the span of 4 years does not mean that a third of women in this age group take an opioid drug all of the time. I am pretty certain that most of these prescriptions were one time fills for post surgical pain or dental procedures. Also, this is over 4 years. It’s misleading to say that a third.of women in their childbearing years are taking opioid.

  7. marty at 1:35 am

    I get very upset by so many people in chronic pain groups who can’t even hold their heads up half the time that are getting pregnant. And then having fits because they can’t or shouldn’t continue on these drugs. I just don’t understand why anyone would risk taking drugs while pregnant. And you can’t tell me the drugs aren’t effecting the fetus. More thought should be put into having a child if you have chronic pain. They are a serious responsibility and hopefully yo can function after they are born with pain meds.

  8. Kurt W.G. Matthies at 4:47 pm

    About 6% of pregnant women were prescribed opioid analgesics, but we still have no data on the relationship between opioids and birth defects.

    Last year we were told:

    “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.”

    Where’s that data?

    Brian Bateman, MD of Harvard Medical School, said: “… 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.”

    Where’s that data?

    Now the CDC says the babies are at risk, especially in the first trimester.

    Where is that data on which this statement is based?

    As we continue to demonize opioid pain medications, many millions are denied treatment and suffer. Others who were getting treatment are now being denied due to inaccurate urinalysis results combined with controlled substance agreements. These unfair agreements, not required by patients who do not have a pain diagnosis, are discriminative.

    Clearly the purpose of this report is to discourage opioid prescribing to pregnant women who are in pain.

    Denying effective pain treatment including opioid analgesics violates all four principles of medical ethics according to Harvard Medical School: failing to do good (benficence), failing to “do no harm” (nonmaleficience), destroying the right to and capacity for self determination of a person in pain (autonomy), and ignoring the humanitarian and financial costs of undertreated pain (justice).

    The IASP delegates in 2010 declared pain management to be a fundamental human right.

    Yet the US medical establishment continues to barrage the media with a propaganda war on the most effective weapon in the fight against pain and suffering, opioid analgesics.

    How long will we allow biases against the use of long-term opioid therapy interfere with effective treatment options and quality of life choices for the many millions of Americans who suffer from chronic intractable pain?

    All medical treatment carries risks, and is therefore based on the concept of informed consent. Pregnant women, the elderly, young adults, and other people in pain have a right to choose from all available treatment options with the guidance of their chosen medical practitioner. And those choices should be made without fear of reprisal against the practitioner, and with unbiased information made available to the patient regarding the risks and benefits for all treatment options.