Awareness needed in dangers of opioid use during pregnancy

WASHINGTON — We have long heard about the dangers of alcohol and pregnancy, but some prescription-strength pain or cough medications can also damage an unborn child.

The problem is there is not enough public awareness of the link between birth defects and prescription opioids such as hydrocodone, codeine and oxycodone, and women are taking these drugs who may be pregnant and don’t know it.

“Opioids have long been thought to be comparatively acceptable in pregnancy and now we are finding that especially in the first trimester that opioids do, in fact, cause birth defects,” says Dr. Cynthia King, an OB-GYN in Bethesda and Rockville, Maryland.

She says women need to be informed about the risk, adding “it is a matter of really raising awareness among the general public and among patients in particular.”

The Centers for Disease Control and Prevention is launching a campaign to get the word out. According to the CDC, more than a third of reproductive-aged women covered by Medicaid and more than a quarter of those with private insurance filled a prescription for one of these drugs each year between 2008 and 2012. The CDC says some may have unknowingly exposed their unborn child.

There is no talk of putting new restrictions on these drugs, which King says can help pregnant women in severe pain if used in moderation. She says while doctors who are not OB-GYNS are careful about giving these drugs to pregnant patients, sometimes “a patient doesn’t realize she is pregnant, or they don’t provide that information to their non-OB-GYN provider and, therefore, they are having this exposure very early in pregnancy.”

The risk from these drugs can vary from woman to woman. Some take opioids and have healthy babies, while others give birth to newborns with problems with their spines, hearts or abdominal walls. There is also a chance a baby could go through withdrawal from opioids taken in pregnancy, but that is not a given either.

“That’s why the CDC is being very careful not to be absolute about it,” says King, adding “they are saying this is something that requires further study, this is something patients need education about so we can all make more informed decisions.”

She notes that pregnant women already have very limited pain management options and it would be “inhumane” to tell them they can’t have access to these drugs when they are really suffering.

King says, “In the second and third trimester they can be used for short periods of time, as prescribed.” She also says women need to be upfront with their doctor about the possibility they could be pregnant. This OB-GYN says when asked that question — even if she was not planning on having a child — a woman should just pause and say, ‘let’s check that out before I go and do this.’

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