More Opioid Drugs Being Prescribed In Pregnancy – At What Risk?

Opioid Drugs On Rise In Pregnancy

A new study on the number of opioid drugs prescribed for pregnant women shows an alarming increase, and that is not a good thing, because other recent studies have linked opioid use with birth defects, some of them quite serious.

According to the New York Times, last week Obstetrics & Gynecology released a cohort study of 1.1 million pregnant women who were on Medicaid in the US. Researchers found that the number of women who filled a prescription for opioids during pregnancy increased from 18.5% in 2000 to almost 23% in 2007. Medicaid covers 45% of all births in the United States.

It is not just women on Medicaid who are increasingly being prescribed opioids. Another study was released in February by Anesthesiology of a half million women on private insurance, which found that fully 14% of those women were prescribed opioid painkillers at least once during their pregnancy.

Of note is the disparity between regions of the numbers of opioid prescriptions. Women in the Northwest and Northeast had fewer of the narcotics prescribed, while rates were found to be highest in the South and mountain states. Oregon had the lowest rate, at 9.5%, and New York was next, at 9.6%. The highest rate of opioid prescription was Utah, at 41.6%, followed by Idaho, at 35.6%.

Stanford University professor of anesthesiology and pain medicine, Dr. Pamela Flood, says that “the regional variation really concerned me the most. It’s hard to imagine that pregnant women in the South have all that much more pain than pregnant women in the Northeast.”

The most commonly prescribed drugs in the opioid class were codeine, hydrocodone, and oxycodone.

Though no drug is completely “safe” and all pharmaceuticals carry risks and side effects, some drugs are less safe than others. When drugs are combined with pregnancy, there are often increased risks. That appears to be the case with the opioid drugs. A number of studies have linked opioids, especially those taken in the first trimester of pregnancy, to some very significant birth defects.

According to a 2011 population-based study from the Centers for Disease Control and Prevention (CDC), women taking opioids in the first trimester had a 2- to 3-fold increased risk of having babies with heart defects like conoventricular septal defects, atrioventricular septal defects, hypoplastic left heart syndrome, as well as spina bifida, and gastroschisis, a condition where the baby’s intestinal organs develop on the outside of the baby’s body.

It is unclear why so many more opioids are being prescribed, but that increase comes at a time when so many women are increasingly conscientious about every thing they put in their body when they are pregnant. Dr. Joshua A. Copel, a professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine in New Haven, Conn., said that “to hear that there’s such a high use of narcotics in pregnancy when I see so many women who worry about a cup of coffee seems incongruous.”

Part of the blame could lie with cultural attitudes that seem to perceive anything prescribed by a doctor as fine, because the perception is that surely they would not recommend something that could hurt the baby. But the reality is that few drugs have actually been studied for their effects on unborn babies. People tend to want something to fix every problem, and prescriptions, including opioids, are often a quick way of placating patients.

Ironically, many doctors freely prescribe medications to pregnant women, when the teratonogenic effects are greatest, while refraining from prescribing to lactating women. Though drugs are excreted in breastmilk, thereby reaching the baby, far more of the drugs cross the placental barrier in pregnant women to reach the developing baby. There are certainly some medications that should not be taken while breastfeeding, including radioactive medications, but most medications carry far greater risk for a baby in the womb than for one who has been born and is nursing. Dr. Thomas Hale’s Infant Risk Center is a publicly accessible resource for finding risk levels for medications for pregnant and breastfeeding mothers.

Baby Nursing

Opioids are painkillers, and there are reasons that women ask for painkillers in pregnancy. While some discomforts of pregnancy are fairly normal, often they may be quite challenging. Women do not want their pain minimized or ignored, so what options are there when pain gets in the way of life?

Actually, there are a number of non-pharmacological options. Sometimes, pain is the body’s way of communicating that mother is doing too much. She may need to get off her feet, or rest, even if her mind is screaming a million things she needs to do.

Chiropractic care or massages can provide great relief for some pregnancy-related complaints.

Less Opioids, More Massages In Pregnancy

Homeopathic arnica montana is well-known for inflammation, muscle soreness, and aches and pains. Homeopathic remedies are generally regarded as safe in pregnancy.

Some herbs can help a wide variety of issues. Some herbs are contra-indicated in pregnancy, however, and it is wise to consult a person who is knowledgeable about herbs. “Naturally Healthy Pregnancy,” by Shonda Parker, master herbalist, is a handy book on the topic.

Essential oils such as peppermint, copaiba, Deep Relief or Stress Away blends can provide some natural pain relief. Naturopathic Doctor Debra Raybern’s book “Gentle Babies: Essential Oils and Natural Remedies for Pregnancy, Childbirth, and Infants” is a great resource for learning about natural oils for pregnancy-related pain and issues.

Though the use of opioid drugs in pregnancy has sky-rocketed in recent years, there are other options for pregnant women in pain. There may be times that they may still be warranted, but certainly not at the rates they are being used presently. Their usage may endanger the baby in the womb, and it is up to mothers to seek out other, safer options and not turn so quickly to dangerous opioid painkillers. Those options are out there. Opioids, like many other drugs, often carry a cost that is higher than many are willing to pay, especially for pregnant women.