In recent decades the use of opioids during pregnancy has risen dramatically, and estimates suggest that as many as 20% of women may use opioids during pregnancy. This use carries significant consequences for mothers, babies, and society.
Opioids and addiction
Opioids are prescription painkillers that are often prescribed after surgeries or injuries. Codeine, morphine, fentanyl, oxycodone, and hydrocodone are common opioids. These drugs should, in most cases, be used for a short time, but many people continue taking them long after the initial pain or injury has healed because opioids are highly addictive. In addition to relieving pain, opioids release chemicals that make you feel calm and happy, which makes you want to take them even if you don’t need them.
With a drug addiction, you become physically and psychologically dependent on the drug, meaning your body tells you that you need it, even if it’s harmful to you. And, your body will crave more and more of the drug to achieve the same feeling. For some people, a legitimate, legal prescription for short-term pain control can eventually lead to illegal drug-seeking behavior. People who use opioids inappropriately or without a prescription (called opioid use disorder) may even start using heroin or cocaine to achieve the same feeling as from opioids.
Opioids and pregnancy
If you need a pain-relieving medicine, make sure your doctor knows if you are pregnant. Discuss all the risks and benefits of all treatment options for your pain: an opioid may be the right choice for you, but other medicines or therapies may help, as well. If you receive a prescription for opioids, take it only exactly as your doctor told you to: do not take it more often or for a longer period of time that you are supposed to. Never take another person’s opioids and do not mix opioids with alcohol or other drugs.
Most women who were taking opioids for chronic (long-lasting) pain before pregnancy continue taking opioids during pregnancy. In recent decades the use of opioids during pregnancy has risen dramatically, and estimates suggest that as many as 20% of women may use opioids during pregnancy. This use carries significant consequences for mothers, babies, and society. Risks to mothers include increased chance of infection, malnutrition, poor prenatal care, and violence and incarceration due to drug-seeking behaviors. Risks to unborn babies include episodes of withdrawal due to fluctuating levels of opioids, stunted growth, preterm labor, fetal convulsions, and fetal death. Birth defects such as problems with the brain, spine, or spinal cord; heart problems; and malformations of the intestines and abdomen may occur in babies born to mothers who took opioids.
Babies born to mothers who use opioids during pregnancy are also at risk for neonatal abstinence syndrome (NAS), which occurs when an infant becomes dependent on the drugs used by mothers during pregnancy. NAS causes an infant to experience tremors, diarrhea, fever, irritability, seizures, and feeding difficulties. NAS now occurs at a rate that is more than 5 times the rate at which it occurred 20 years ago.
Opioid dependence can be treated with methadone, buprenorphine, or naltrexone during pregnancy.[1-3] NAS occurs less frequently in babies whose mothers were treated for opioid dependence: if NAS does still occur after a mother undergoes treatment, it is often less severe.
By treating mothers for opioid dependence, fetal levels of opioid exposure are stabilized, mothers receive appropriate prenatal care, and long-term health outcomes are improved for both mother and child. Women who are treated for opioid dependence during pregnancy give birth to babies with higher gestational age, higher birth weight, and larger head circumference compared to women who did not receive treatment.
The benefits of treating opioid dependence during pregnancy generally outweigh the risks, but the safety of methadone, buprenorphine, and naltrexone during pregnancy has not been well established. Studies of pregnant animals suggest that these drugs may change pain sensitivity, alter developmental processes, and change behavioral responses in children born to mothers who received these drugs during pregnancy. If your doctor recommends opioid dependence treatment, be sure to discuss all the risks and benefits of all therapeutic options.
In addition to medication-based therapies, social, emotional, and psychological support is also critical. Counseling can help you cope with your feelings about drugs and teach you important life skills that will help you stay healthy and drug free.
Opioids and safety
Most people who take opioids use them safely and do not become addicted. However, you may be at increased risk for developing an addiction if you have a family history of addiction, have a mental health condition such as anxiety, depression, or post-traumatic stress, or are around people who use drugs. If you notice that you are taking more opioids than your doctor said you could take, if you have strong cravings to take opioids, or if taking opioids is causing problems at work, home, or school, you may have opioid use disorder.
Opioid use disorder puts you at risk for overdose. If you are taking an opioid and notice any of the following symptoms, call 911 immediately.
- Blurred vision
- Cold, clammy skin
- Feeling dizzy, faint, or sleepy
- Loose, floppy muscles
- Slowed breathing
- Slowed heartbeat
Do not stop taking an opioid without talking to your healthcare provider. Stopping a drug like this suddenly can harm you and your baby.
If you think you may have opioid use disorder, seek help from your healthcare provider. He or she can direct you to resources for opioid treatment and help you have a healthy pregnancy. Join a support group for other people who are struggling with substance use issues and accept your family’s offers for help. Most importantly, take care of yourself. Your health is the most important determinant of your baby’s health.
- Raymond BL, Kook BT, Richardson MG. The opioid epidemic and pregnancy: implications for anesthetic care. Curr Opin Anaesthesiology. 2018;31(3):243-50.
- Wilder CM, Winhusen T. Pharmacological management of opioid use disorder in pregnant women. CNS drugs. 2015;29(8):625-36.
- Tran TH, Griffin BL, Stone RH, et al. Methadone, buprenorphine, and naltrexone for the treatment of opioid use disorder in pregnant women. Pharmacotherapy. 2017;37(7):824-39.