Opioid use during pregnancy

Opioid use poses special concerns for people who are pregnant. Understand the potential risks of opioid use during pregnancy and how opioid use might affect your prenatal care.

What are the concerns about opioid use?

Opioid medications, commonly called narcotics, are derived from the poppy plant. Some opioids are available as prescription medications.

While these medications are an important option for managing pain, repetitive use can lead to dependence, physical tolerance, craving, inability to control use and continued use despite harmful consequences (opioid use disorder). Addiction and overdose are serious risks.

Before using prescription opioids for pain, talk to your doctor about the risks and benefits, as well as your treatment goals. In addition, be sure to tell your doctor if you are pregnant and discuss your family planning goals.

What risks does opioid use during pregnancy pose?

Opioids used during pregnancy might cross the placenta and enter the fetal central nervous system. Although occasional use of opioids during pregnancy doesn't typically pose concerns for the baby, use of opioids close to delivery might cause the baby to experience slow and ineffective breathing (respiratory depression) after birth.

In contrast, many complications have been associated with opioid dependency during pregnancy, including:

• Placental problems, including placental abruption and placental insufficiency
• Premature rupture of membranes
• Preterm labor and premature birth
• Fetal growth restriction
• Preeclampsia
• Miscarriage or fetal death
• Postpartum heavy bleeding
• Inflammation of the fetal membranes (intra-amniotic infection)

However, it's difficult to determine the extent to which these complications are due to opioids or opioid withdrawal. Use of other drugs or your own health, nutritional or psychological conditions might play a role.

If you become opioid dependent during pregnancy, your baby could experience the drug withdrawal syndrome known as neonatal abstinence syndrome. Signs and symptoms, which often begin shortly after birth and might last days to weeks, include:

• Tremors
• Jitteriness
• Diarrhea
• Uncoordinated sucking reflexes that lead to poor feeding
• Irritability
• High-pitched cry
• Poor sleep

Your baby might need to be hospitalized for weeks.

Is it ever OK to use opioids during pregnancy?

The American College of Obstetricians and Gynecologists states that pregnancy shouldn't be a reason to avoid treating acute pain because of concern for opioid misuse or neonatal abstinence syndrome.

If you're pregnant and experiencing chronic pain, your doctor will aim to avoid or minimize the use of opioids. He or she will likely highlight alternative therapies, such as exercise, physical therapy and behavior therapy, and nonopioid medications. If you are prescribed opioids during pregnancy, you'll likely be told to use the medications for the shortest time possible.

If you are pregnant and have opioid use disorder, your doctor will recommend an opioid substitution medication. This involves use of the opioid medication methadone in combination with counseling and behavior therapy. This therapy has been shown to prevent opioid withdrawal symptoms, reduce the risk of relapse, and improve commitment to prenatal care and addiction treatment programs.

How does opioid use disorder affect prenatal care?

If you use opioids during pregnancy or have opioid use disorder during pregnancy, depending on your individual situation, your doctor might:

• Test you for sexually transmitted infections and other infectious diseases more frequently
• Screen you for depression and other behavioral health conditions
• Recommend a first trimester ultrasound to accurately date your pregnancy
• Consult with various specialists to meet your and your baby's health care needs
• Screen for and discuss use of other substances, such as tobacco
• Discuss a pain management plan during labor based on your individual needs and desires
• Encourage breast-feeding, as long as you are stable on your opioid substitute medication, not using illicit drugs and have no other contraindications
• Recommend that you continue your opioid substitution medication after delivery to prevent relapse
• Discuss with you contraceptive options after delivery

If you have acute pain during pregnancy, talk to your health care provider about the safest treatment options. If you are pregnant and think you might have developed an opioid use problem, talk to your health care provider right away. He or she can help you get the treatment needed to protect your and your baby's health.