Pregnancy and Opioids

Many women need to take medicines while they are pregnant. But not all medicines are safe during pregnancy. Many medicines carry risks for you, your baby, or both. Opioids, especially when misused, can cause problems for you and your baby while you are pregnant.

What are opioids?

Opioids, sometimes called narcotics, are a type of drug. They include strong prescription pain relievers, such as oxycodone, hydrocodone, fentanyl, and tramadol. The illegal drug heroin is also an opioid.

A health care provider may give you a prescription opioid to reduce pain after you have had a major injury or surgery. You may get them if you have severe pain from health conditions like cancer. Some health care providers prescribe them for chronic pain.

Prescription opioids used for pain relief are generally safe when taken for a short time and as prescribed by your health care provider. However, opioid dependence, addiction, and overdose are still potential risks. These risks increase when these medicines are misused. Misuse means you are not taking the medicines according to your provider's instructions, you are using them to get high, or you are taking someone else's opioids.

What are the risks of taking opioids during pregnancy?

Taking opioids during pregnancy can cause problems for you and your baby. The possible risks include

• Neonatal abstinence syndrome (NAS) - withdrawal symptoms (irritability, seizures, vomiting, diarrhea, fever, and poor feeding) in newborns
• Neural tube defects - birth defects of the brain, spine, or spinal cord
• Congenital heart defects - problems with the structure of the baby's heart
• Gastroschisis - a birth defect of the baby's abdomen, where the intestines stick outside of the body through a hole beside the belly button
• Loss of the baby, either miscarriage (before 20 weeks of pregnancy) or stillbirth (after 20 or more weeks)
• Preterm delivery - a birth before 37 weeks
• Stunted growth, leading to low birthweight

Some women need to take opioid pain medicine while they are pregnant. If your health care provider suggests that you take opioids during pregnancy, you should first discuss the risks and benefits. Then if you both decide that you need to take the opioids, you should work together to try to minimize the risks. Some of the ways to do this include

• Taking them for the shortest time possible
• Taking the lowest dose that will help you
• Carefully following your provider's instructions for taking the medicines
• Contacting your provider if you have side effects
• Going to all your follow-up appointments

If I am already taking opioids and I become pregnant, what should I do?

If you have been taking opioids and you become pregnant, contact your health care provider. You should not stop taking the opioids on your own. If you suddenly stop taking opioids, it could cause severe health problems for you or your baby. In some cases, stopping suddenly during pregnancy may be more harmful than taking the medicines.

Can I breastfeed while taking opioids?

Many women who regularly take opioid medicines can breastfeed. It depends on which medicine you are taking. Check with your health care provider before breastfeeding.

There are some women who should not breastfeed, such as those who have HIV or take illegal drugs.

What are the treatments for opioid use disorders in pregnancy?

If you are pregnant and have an opioid use disorder, do not stop taking opioids suddenly. Instead, see your health care provider so you can get help. The treatment for opioid use disorder is medication-assisted therapy (MAT). MAT includes medicine and counseling:

• Medicine can reduce your cravings and withdrawal symptoms. For pregnant women, health care providers use either buprenorphine or methadone.
• Counseling, including behavioral therapies, which can help you
• Change your attitudes and behaviors related to drug use
• Build healthy life skills
• Continue taking your medicine and getting prenatal care