Medical professionals and pregnant women need to decide between pain management and the health of an unborn baby when it comes to opioid prescriptions.
For many expecting parents, the 9 months of pregnancy often revolves around one question.
Will the baby be OK?
For babies who have exposure to opioids in utero, the answer isn’t clear cut.
“Parents and clinicians are very concerned about what effect prenatal opioid exposure has on the development of the child,” Elisabeth Conradt, PhD, a University of Utah developmental psychologist, told Healthline.
She said she discovered that the literature available doesn’t provide many answers.
“We found that we know very little because the existing research is small and there are some major methodological problems in the vast majority of studies reviewed. For example, sample sizes are small or studies failed to control for important confounds, such as exposure to poverty,” she said.
In the absence of definitive research, medical practitioners weigh the risks and benefits of prescribing opioids for pregnant women on an individual basis.
“The decision to prescribe opioids to a pregnant patient should be a highly individualized conversation between the physician and patient, weighing the risks of opioids against the necessary pain relief. In cases of severe and refractory pain that impairs a person’s ability to function in the ways they need to in the world, opioids might be prescribed,” Dr. Alicia Agnoli, an assistant professor in the department of family and community medicine at the University of California, Davis, told Healthline.
In some cases, pregnant women with opioid use disorder may also be prescribed opioids.
“Buprenorphine or methadone is prescribed as medication for opioid use disorder. In this case, the prescribed medication treats the addiction, suppressing cravings and reducing the risks of illicit opioid use to both mother and baby,” Agnoli said.
Opioids are a group of drugs that provide pain relief.
They work by traveling through the blood and attaching to cells that then release a signal to the brain to dampen feelings of pain.
As well as dulling pain, the medications can also give a boost of pleasure.
This is the reason the drugs can be effective but also dangerous. Seeking the feeling of pleasure that can come from opioids can result in addiction.
During the 1990s, pharmaceutical companies stated that people would not become addicted to opioids, and doctors started prescribing them more frequently. This led to misuse of both prescription opioids and nonprescription opioids such as heroin.
In 2017, the Department of Health and Human Services declared a public health emergency due to the opioid crisis.
Today, it’s estimated that 2 million people have an opioid use disorder and 11 million people misuse prescription opioids.
“Opioid use during pregnancy carries an increased risk of poor birth outcomes, such as preterm labor, miscarriage, growth restriction, and exposure to bloodborne infections like hepatitis C and HIV,” Agnoli said.
“There is also the risk of neonatal abstinence syndrome, which is a condition brought about by the sudden absence of opioids from the maternal blood supply following delivery,” she added. “It occurs in the first few days of life and, though highly variable, most commonly consists of crying, irritability, and poor feeding, but can have a more serious or protracted course requiring medications and more invasive intervention.”
Dr. Alex Peahl, an obstetrician and health services researcher at the University of Michigan, says many women who previously had not taken opioids are prescribed them after birth.
“We see that rates of opioid prescribing in the U.S. after healthcare encounters like childbirth are high.
Peahl says there are circumstances when a pregnant woman might need pain management.
Kidney stones, appendectomy, gallbladder surgery, or preterm labor are some examples where physicians may prescribe opioids.
Pain management in pregnancy is complicated by the fact that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can’t be used during pregnancy due to potential risks to the fetus.
“Without these medications, there are fewer options for pregnant women. Ensuring women’s pain is adequately controlled is an important part of managing these acute situations,” Peahl said.
“While many people are doing excellent work to understand the breadth and impact of opioid prescribing in pregnancy, there is still a gap in our understanding of how acute prescribing impacts women, their future opioid use, and their children,” she said.
Dr. Daniel Colby is a specialist in emergency medicine and toxicology at UC Davis. He says substance use disorder can stop pregnant women from seeking the care they need.
“Due to the fact that they have already been stigmatized and don’t feel like they’ve been treated well by our healthcare system and our culture, they then don’t seek out the care they should get both for the opioid use problem and the pregnancy itself,” he told Healthline.
For women with opioid use disorder, he advises they seek help from a medical provider who can prescribe medications to manage their addiction.
“The risk-benefit seems pretty clear that we’re better getting someone off heroin, off fentanyl, off a pill… like oxycodone… and onto a medication like buprenorphine, that is clearly a form of harm reduction. That’s the right thing to do for both the mother and the potential child,” he said.
Agnoli agrees that systemic stigma can prevent those with opioid use disorder from seeking help.
“This is further amplified during pregnancy, when judgment and shame around opioid use can further alienate a pregnant patient during a vulnerable period of time. Personal bias against opioid use in a pregnant patient can be a further toxic insult for a developing fetus, shaming the mother and leading her to disengage from prenatal care or feel reluctant to ask for help,” she said.
“We have to keep all doors open to pregnant patients if we want to make meaningful progress in health outcomes of parents and babies exposed to opioids,” she added.