Opioids Use in Pregnancy and Its Implications
Article Sidebar
Published:
Mar 5, 2020
Keywords:
codeine, fentanyl, morphine, meperidine, neonatal abstinence syndrome, pregnancy, teratogenicity, tramadol
Main Article Content
Abstract
Pregnant women require opioids analgesic
medications to treat various acute and chronic pain
conditions. It is acknowledged that opioids in the maternal
blood are transferred across the placenta to the fetus.
A retrospective study suggested that some opioids used
in periconceptual period and the first trimester of
pregnancy were associated with an increase in neural tube
defect, gastroschisis and congenital heart anomaly in
human fetuses. Chronic use of opioids in pregnancy
through the third trimester can cause neonatal abstinence
syndrome (NAS), that is, the presence of withdrawal
symptoms of opioids in the newborn.
The aim of this article is to review the literatures
related to opioids use in pregnancy, including the potential
teratogenic risks to fetuses and neonatal abstinence
syndrome. It is imperative to emphasize that opioids
should be used in pregnant woman in as low an amount
as possible for effective pain control and only if benefits
to the mother outweigh risks of any possible adverse effect
to the fetus or the newborn.
Article Details
Section
Review articles
References
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non-obstetric surgery during pregnancy. Br J Anaesth
2011;107(Suppl 1):i72-8.
2. Van De Velde M. Nonobstetric surgery during pregnancy.
In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin
Y, Mhyre JM, editors. Chestnut’s obstetric anesthesia:
principles and practice. 5th ed. Philadelphia: Elsevier; 2014.
p.358-79.
3. Rollins MD, Rosen MA. Anesthesia for fetal surgery and
other intrauterine procedure. In: Chestnut DH, Wong CA,
Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, editors.
Chestnut’s obstetric anesthesia: principles and practice. 5th
ed. Philadelphia: Elsevier; 2014. p.128-47.
4. Nivatpumin P, Pangthipampai P, Jirativanont T, Dej-arkom
S, Triyasunant N, Tempeetikul T. Anesthetic techniques and
incidence of complications in fetoscopic surgery. J Med
Assoc Thai 2016;99(5):602-10.
5. Bauchat J, Wong CA. Pain management during pregnancy
and lactation. In: Benzon HT, Raja SN, Fishman SM, Liu SS,
Cohen SP, editors. Essential of pain medicine. 3rd ed.
Philadelphia: Elsevier; 2011. p.249-52.
6. Nivatpumin P. Acute pain management in pregnancy and
breastfeeding mother. In: Sanansilp V, Tangwiwat S,
Raksakietisak M, editors. Acute pain management. Bangkok:
P.A. Living;2019. p.307-20.
Epstein RA, Bobo WV, Martin PR, et al. Increasing
pregnancy-related use of prescribed opioid analgesics. Ann
7.Epidemiol 2013 ;23(8):498-503.
8. Gin T, Yankowitz J. Pharmacology and nonobstetric drugs
during pregnancy and lactation. In: Chestnut DH, Wong CA,
Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, editors.
Chestnut’s obstetric anesthesia: principles and practice.
5th ed. Philadelphia: Elsevier; 2014. p.303-25.
9. Baldacchino A, Arbuckle K, Petrie DJ, McCowan C. Erratum:
neurobehavioral consequences of chronic intrauterine opioid
exposure in infants and preschool children: a systematic
review and meta-analysis. BMC Psychiatry [Internet]. 2015
Jun 25. doi: 10.1186/s12888-015-0438-5
10. Geber WF, Schramm LC. Congenital malformations of the
central nervous system produced by narcotic analgesics in
the hamster. Am J Obstet Gynecol 1975;123(7):705-13.
11. Williams J, Price CJ, Sleet RB, et al. Codeine: developmental
toxicity in hamsters and mice. Fundam Appl Toxicol 1991;
16:401-13.
12. Yazdy MM, Mitchell AA, Tinker SC, Parker SE, Werler MM.
Periconceptional use of opioids and the risk of neural tube
defects. Obstet Gynecol 2013;122(4):838-44.
13. Broussard CS, Rasmussen SA, Reefhuis J, et al. National
Birth Defects Prevention Study. Maternal treatment with
opioid analgesics and risk for birth defects. Am J Obstet
Gynecol 2011;204(4):314.e1-314.
14. Lind JN, Interrante JD, Ailes EC, et al. Maternal Use of
Opioids During Pregnancy and Congenital Malformations:
A Systematic Review. Pediatrics 2017;139(6), pii: e20164131.
15. Hadi I, da Silva O, Natale R, Boyd D, Morley-Forster PK.
Opioids in the parturient with chronic nonmalignant pain:
a retrospective review. J Opioid Manag 2006;2(1):31-4.
16. Kelly L, Dooley J, Cromarty H, et al. Narcotic-exposed
neonates in a First Nations population in northwestern
Ontario: incidence and implications. Can Fam Physician
2011;57(11):e441-7.
17. Källén B, Borg N, Reis M. The use of central nervous system
active drugs during pregnancy. Pharmaceuticals (Basel)
2013;6(10): 1221-86
18. Nezvalová-Henriksen K, Spigset O, Nordeng H. Effects of
codeine on pregnancy outcome: results from a large
population-based cohort study. Eur J Clin Pharmacol 2011;
67(12):1253-61
19. Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in
pregnancy and birth outcomes: A review of the literature.
J Pediatr Genet 2015;4(2):56-70.
20. Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends
in narcotic use in pregnancy and neonatal outcomes. Am J
Obstet Gynecol 2011;204(3):259.e1-259.e4
21. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics
2014;134(2):e547-61.
22. Nanovskaya TN, Nekhayeva, Hankins GDV, Ahmed MS.
Transfer of methadone across the dually perfused preterm
human placental lobule. Am J Obstet Gynecol 2008: 198:126.
e1-e4.
23. Reddy UM, Davis JM, Ren Z, Greene MF, Opioid Use in
Pregnancy, Neonatal Abstinence Syndrome, and Childhood
Outcomes Workshop Invited Speakers. Opioid Use in
Pregnancy, Neonatal Abstinence Syndrome, and Childhood
Outcomes: Executive Summary of a Joint Workshop by the
Eunice Kennedy Shriver National Institute of Child Health
and Human Development, American College of Obstetricians
and Gynecologists, American Academy of Pediatrics, Society
for Maternal-Fetal Medicine, Centers for Disease Control and
Prevention, and the March of Dimes Foundation. Obstet
Gynecol 2017;130(1):10-28.
24. Bagley SM, Wachman EM, Holland E, Brogly SB. Review of
the assessment and management of neonatal abstinence
syndrome. Addiction Science and Clinical Practice [Internet].
2014 Sep 9;9(1):19. doi: 10.1186/1940-0640-9-19.
25. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and
lactation. 9th ed. Philadelphia. Lippincott Williams and Wilkins;
2011.
26. Crawford JS, Rudofsky S. The placental transmission of
pethidine. Br J Anaesth 1965; 37:929-33.
27. Cooper J, Jauniaux E, Gulbis B, Quick D, Bromley L.
Placental transfer of fentanyl in early human pregnancy and
its detection in fetal brain. Br J Anaesth 1999;82(6):929-31.
28. Regan J, Chambers F, Gorman W, MacSullivan R. Neonatal
abstinence syndrome due to prolonged administration of
fentanyl in pregnancy. BJOG 2000;107(4):570-2.
29. Bloor M, Paech MJ, Kaye R. Tramadol in pregnancy and
lactation. Int J Obstet Anesth 2012;21(2):163-7.
30. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for
the use of chronic opioid therapy in chronic noncancer pain.
J Pain 2009;10(2):113-30.
31. Dowell D, Haegerich TM, Chou R. CDC Guideline for
Prescribing Opioids for Chronic Pain-United States, 2016.
JAMA 2016;315(15):1624-45.
32. Olutoye OA, Baker BW, Belfort MA, Olutoye OO. Food and
Drug Administration warning on anesthesia and brain
development: implications for obstetric and fetal surgery.
Am J Obstet Gynecol 2018;218(1):98-102.
non-obstetric surgery during pregnancy. Br J Anaesth
2011;107(Suppl 1):i72-8.
2. Van De Velde M. Nonobstetric surgery during pregnancy.
In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin
Y, Mhyre JM, editors. Chestnut’s obstetric anesthesia:
principles and practice. 5th ed. Philadelphia: Elsevier; 2014.
p.358-79.
3. Rollins MD, Rosen MA. Anesthesia for fetal surgery and
other intrauterine procedure. In: Chestnut DH, Wong CA,
Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, editors.
Chestnut’s obstetric anesthesia: principles and practice. 5th
ed. Philadelphia: Elsevier; 2014. p.128-47.
4. Nivatpumin P, Pangthipampai P, Jirativanont T, Dej-arkom
S, Triyasunant N, Tempeetikul T. Anesthetic techniques and
incidence of complications in fetoscopic surgery. J Med
Assoc Thai 2016;99(5):602-10.
5. Bauchat J, Wong CA. Pain management during pregnancy
and lactation. In: Benzon HT, Raja SN, Fishman SM, Liu SS,
Cohen SP, editors. Essential of pain medicine. 3rd ed.
Philadelphia: Elsevier; 2011. p.249-52.
6. Nivatpumin P. Acute pain management in pregnancy and
breastfeeding mother. In: Sanansilp V, Tangwiwat S,
Raksakietisak M, editors. Acute pain management. Bangkok:
P.A. Living;2019. p.307-20.
Epstein RA, Bobo WV, Martin PR, et al. Increasing
pregnancy-related use of prescribed opioid analgesics. Ann
7.Epidemiol 2013 ;23(8):498-503.
8. Gin T, Yankowitz J. Pharmacology and nonobstetric drugs
during pregnancy and lactation. In: Chestnut DH, Wong CA,
Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, editors.
Chestnut’s obstetric anesthesia: principles and practice.
5th ed. Philadelphia: Elsevier; 2014. p.303-25.
9. Baldacchino A, Arbuckle K, Petrie DJ, McCowan C. Erratum:
neurobehavioral consequences of chronic intrauterine opioid
exposure in infants and preschool children: a systematic
review and meta-analysis. BMC Psychiatry [Internet]. 2015
Jun 25. doi: 10.1186/s12888-015-0438-5
10. Geber WF, Schramm LC. Congenital malformations of the
central nervous system produced by narcotic analgesics in
the hamster. Am J Obstet Gynecol 1975;123(7):705-13.
11. Williams J, Price CJ, Sleet RB, et al. Codeine: developmental
toxicity in hamsters and mice. Fundam Appl Toxicol 1991;
16:401-13.
12. Yazdy MM, Mitchell AA, Tinker SC, Parker SE, Werler MM.
Periconceptional use of opioids and the risk of neural tube
defects. Obstet Gynecol 2013;122(4):838-44.
13. Broussard CS, Rasmussen SA, Reefhuis J, et al. National
Birth Defects Prevention Study. Maternal treatment with
opioid analgesics and risk for birth defects. Am J Obstet
Gynecol 2011;204(4):314.e1-314.
14. Lind JN, Interrante JD, Ailes EC, et al. Maternal Use of
Opioids During Pregnancy and Congenital Malformations:
A Systematic Review. Pediatrics 2017;139(6), pii: e20164131.
15. Hadi I, da Silva O, Natale R, Boyd D, Morley-Forster PK.
Opioids in the parturient with chronic nonmalignant pain:
a retrospective review. J Opioid Manag 2006;2(1):31-4.
16. Kelly L, Dooley J, Cromarty H, et al. Narcotic-exposed
neonates in a First Nations population in northwestern
Ontario: incidence and implications. Can Fam Physician
2011;57(11):e441-7.
17. Källén B, Borg N, Reis M. The use of central nervous system
active drugs during pregnancy. Pharmaceuticals (Basel)
2013;6(10): 1221-86
18. Nezvalová-Henriksen K, Spigset O, Nordeng H. Effects of
codeine on pregnancy outcome: results from a large
population-based cohort study. Eur J Clin Pharmacol 2011;
67(12):1253-61
19. Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in
pregnancy and birth outcomes: A review of the literature.
J Pediatr Genet 2015;4(2):56-70.
20. Kellogg A, Rose CH, Harms RH, Watson WJ. Current trends
in narcotic use in pregnancy and neonatal outcomes. Am J
Obstet Gynecol 2011;204(3):259.e1-259.e4
21. Kocherlakota P. Neonatal abstinence syndrome. Pediatrics
2014;134(2):e547-61.
22. Nanovskaya TN, Nekhayeva, Hankins GDV, Ahmed MS.
Transfer of methadone across the dually perfused preterm
human placental lobule. Am J Obstet Gynecol 2008: 198:126.
e1-e4.
23. Reddy UM, Davis JM, Ren Z, Greene MF, Opioid Use in
Pregnancy, Neonatal Abstinence Syndrome, and Childhood
Outcomes Workshop Invited Speakers. Opioid Use in
Pregnancy, Neonatal Abstinence Syndrome, and Childhood
Outcomes: Executive Summary of a Joint Workshop by the
Eunice Kennedy Shriver National Institute of Child Health
and Human Development, American College of Obstetricians
and Gynecologists, American Academy of Pediatrics, Society
for Maternal-Fetal Medicine, Centers for Disease Control and
Prevention, and the March of Dimes Foundation. Obstet
Gynecol 2017;130(1):10-28.
24. Bagley SM, Wachman EM, Holland E, Brogly SB. Review of
the assessment and management of neonatal abstinence
syndrome. Addiction Science and Clinical Practice [Internet].
2014 Sep 9;9(1):19. doi: 10.1186/1940-0640-9-19.
25. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and
lactation. 9th ed. Philadelphia. Lippincott Williams and Wilkins;
2011.
26. Crawford JS, Rudofsky S. The placental transmission of
pethidine. Br J Anaesth 1965; 37:929-33.
27. Cooper J, Jauniaux E, Gulbis B, Quick D, Bromley L.
Placental transfer of fentanyl in early human pregnancy and
its detection in fetal brain. Br J Anaesth 1999;82(6):929-31.
28. Regan J, Chambers F, Gorman W, MacSullivan R. Neonatal
abstinence syndrome due to prolonged administration of
fentanyl in pregnancy. BJOG 2000;107(4):570-2.
29. Bloor M, Paech MJ, Kaye R. Tramadol in pregnancy and
lactation. Int J Obstet Anesth 2012;21(2):163-7.
30. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for
the use of chronic opioid therapy in chronic noncancer pain.
J Pain 2009;10(2):113-30.
31. Dowell D, Haegerich TM, Chou R. CDC Guideline for
Prescribing Opioids for Chronic Pain-United States, 2016.
JAMA 2016;315(15):1624-45.
32. Olutoye OA, Baker BW, Belfort MA, Olutoye OO. Food and
Drug Administration warning on anesthesia and brain
development: implications for obstetric and fetal surgery.
Am J Obstet Gynecol 2018;218(1):98-102.