Bone Fractures During Pregnancy and Breastfeeding

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A bone fracture is essentially a crack within a bone, although there are various types of fractures. Pregnant women are at risk for bone fractures due to hormonal changes causing calcium to move from the mother, through the placenta, to the growing fetus. This can lead to pregnancy-induced osteoporosis, which is a decrease in the density of the mineral in bone. Women also are prone to falling near the end of pregnancy, which also contributes to the fracture risk.

Based on the fracture type, as well as the location, the healing time, severity, and possible complications of fractures vary considerably. A simple crack that does not go all the way through the bone is called a greenstick fracture (see image below). Such fracture is much more common in bones of young people, especially children, compared with older people. A linear fracture is a fracture that running lengthwise along a bone, while a transverse fracture runs directly across the width of the bone. A fracture also can be oblique, meaning that it runs at an angle across the width of the bone. All of these types of fractures are called “non-displaced” fractures, meaning that there is no shifting between bone areas on each side of the crack.

Non-displaced fractures that are not in a joint are usually simpler to treat and tend to heal more quickly than fractures within a joint, meaning the region where across the ends of two bones come together. The joint includes ligaments and tendons and often an enclosed cavity containing fluid called synovial fluid. Usually, it is more difficult and takes longer to repair fractures with complex shapes, such as spiral shaped fractures. It is also more difficult to treat fractures in which parts of the bone are separated, when there is a comminuted fracture (the bone is splintered into many pieces). Additionally, any fracture within a joint takes longer and typically requires more intervention to heal.

Another way to classify fractures is based on whether or not they are compound, or “open”, meaning that fractured bone penetrates out through the skin. Fractures are also described as being reducible or not. A reducible fracture is a fracture whose displaced bone parts can be returned to their correct place and stay in place, without surgery and “hardware”, such as plates and screws to hold the parts in place.

Your doctor can diagnose a fracture with an X ray scan. Although many people in western society fear ionizing radiation and its effects during pregnancy, simple X ray scans expose you only to very tiny X ray doses. There is no danger whatsoever to you or your baby, even during the early period of pregnancy, and even when you have a fracture in the lower spin or hip, requiring X ray scanning directly through the womb pass through the womb. On the other hand, there is a real danger if fear of radiation -known as radiophobia- leads you to avoid having a fracture diagnosed. If you have a complicated fracture, requiring computed tomography (CT) scanning of the injured site, the X ray dosage is much higher compared with a simple X ray scan, which may possibly put an embryo or fetus at risk. In such cases, however, the risks connected with a complicated fracture will outweigh the risk from the radiation of CT.

The main treatment for a bone fracture is to reduce (set) the fracture. This means moving the separated bone parts into correct alignment, if the fracture is displaced. If this cannot be done by manipulation from the outside, then surgery will be needed. In order to heal, one or more joints near a fracture that has been set must be immobilized with a splint or cast. More complicated fractures require surgery.

You also will receive medication to combat pain and inflammation. If you require surgery and/or if you have a compound fracture, you also will receive antibiotic medication to prevent or treat infection.  Certain medications work against pain, but not inflammation; these are acetaminophen in the United States and paracetamol in several other countries. In contrast, non-steroidal anti-inflammatory drugs (NSAIDs) are effective against pain and inflammation. NSAIDs include ibuprofen and naproxen. NSAIDs, and related drugs called salicylates, are of concern during pregnancy, as they may be harmful to the embryo or fetus during early and late pregnancy.

Stronger pain medications may be needed during and after surgery and during an external reduction (the orthopedic surgeon sets the fracture by manipulating the bone from the outside without surgery).  The stronger pain relievers are in a group of drugs called opioids (narcotics). There is a concern that long-term use of these of opioids can cause birth defects, but research has failed to demonstrate a danger when the drugs are used just for a few days.

During breastfeeding, there are various antibiotics are available that are considered safe for a nursing infant. On the other hand, opioids could be harmful during breastfeeding, so if you require these drugs you should use infant formula instead. Acetaminophen, paracetamol, and NSAIDs are considered to be breastfeeding safe.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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