Author: Zia Sherrell MPH
Opioids are strong medications that doctors prescribe for pain. Using any of these drugs during pregnancy is risky for both the parent and fetus. Opioids can cause developmental changes, preterm birth, and stillbirth.
Opioids have a high risk for misuse and dependency.
According to the Centers for Disease Control and Prevention (CDC), around 7% of women reported using opioids while pregnant in 2019. Among this group, 20% reported misuse, meaning that they used the medication for a purpose other than to relieve pain, or they obtained the opioids from someone other than a doctor.
Between 2010 and 2017, the number of opioid-related diagnoses at birth increased by 131%, the CDC reports.
For anyone dependent on opioids, help is available. Doctors can create a treatment plan to help people transition to a different medication or stop taking opioids in a way that minimizes the risks. Suddenly stopping opioids is dangerous, so getting the right support is essential.
In this article, learn more about opioids. We describe whether it is possible for pregnant people to take them safely, the associated risks, and the next steps for someone who takes an opioid during pregnancy.
These drugs are addictive, and they cause dependency quickly. In addition to relieving pain, they release chemicals in the brain that produce a feeling of euphoria. This makes a person feel happy and calm.
The more someone uses opioids, the more their body craves this feeling.
Examples of prescription opioids include:
- oxycodone (Oxycontin, Percodan, Percocet)
- hydrocodone (Vicodin, Lorcet, Lortab, Norco)
- morphine (Roxanol, Avinza, Astramorph, Duramorph)
- oxymorphone (Opana)
- tramadol (ConZip, Ultram, Ryzolt)
- fentanyl (Sublimaze, Duragesic, Actiq)
- buprenorphine (Butrans, Belbuca, Probuphine, Buprenex)
An example of an illegal opioid is heroin, which comes from the same source as morphine.
All opioids can cause addiction, whether or not they are available with a prescription. According to the 2020 National Survey on Drug Use and Health, 9.5 million people in the United States misused opioids in the previous year. Of those, 9.3 million said they misused prescription opioids.
Opioids are not safe or beneficial for fetuses. However, depending on the circumstances, a doctor may still prescribe them.
For example, if someone has substance abuse disorder and is taking an opioid, a doctor will not recommend that they suddenly stop. Doing so could be dangerous for the person and their fetus. Instead, the doctor may suggest switching to a long-acting opioid that has fewer risks. This may help the person taper off opioid use gradually.
This does not mean that taking any opioid during pregnancy is safe, but there are ways to reduce the risk of harm. In these instances, the pregnant person must follow the doctor’s instructions precisely.
Anyone taking an opioid during pregnancy should plan to deliver their baby at a facility that can care for the newborn, who may experience withdrawal symptoms.
Another situation in which doctors may prescribe opioids is during the birth, to relieve the pain of delivery. This does not harm the fetus.
Opioids are associated with a range of pregnancy complications, including:
Preterm labor and premature birth
Doctors classify any birth that occurs before 37 weeks as “preterm.” Babies born this early may not have fully developed, which can mean that they have a higher risk of breathing difficulties and health conditions.
Placental abruption is a serious condition that involves the placenta separating from the wall of the uterus before birth. It can prevent the fetus from receiving enough oxygen and nutrients, and it can cause severe bleeding for the pregnant person.
Preeclampsia causes a pregnant person to develop high blood pressure. It can also cause high protein levels in urine, a sign that the liver and kidneys are not working as they should.
Mild preeclampsia does not always cause symptoms, and doctors often detect it during blood pressure monitoring.
When symptoms occur, they can include:
- swelling of the hands and face
- fluid retention
- shortness of breath
- abdominal pain
- severe headaches
- vision changes
Preeclampsia can impair blood flow to the fetus, increasing the risk of growth problems and stillbirth.
A person with preeclampsia usually has to give birth early, which has the same risks for the fetus as other preterm births.
Miscarriage or stillbirth
These terms refer to pregnancy loss. Doctors use the term “miscarriage” if a fetus dies before 20 weeks, and they use “stillbirth” if a fetus dies after 20 weeks.
Opioid use is associated with many health complications after birth and as children grow up, including:
Neonatal abstinence syndrome
A baby who was receiving an opioid through the umbilical cord no longer does after birth, and they go through drug withdrawal.
Neonatal abstinence syndrome (NAS) refers to a group of health conditions that occur when newborns go through withdrawal. The symptoms begin at around 72 hours after birth, and they may include:
- hyperactive reflexes
- vomiting or loose stools
- a stuffy or runny nose
- irritability and crying
- sleep problems
- poor feeding
Withdrawal symptoms that last into the first 28 days are known as neonatal opioid withdrawal, or NOW, syndrome.
NAS can occur even if a person takes an opioid exactly as directed by their doctor. Babies with NAS are more likely to have a low birth weight and breathing problems. However, the effects can vary, based on the opioid.
Opioids can affect how a fetus grows, changing how parts of the body develop. The baby may have a low birth weight or a congenital condition, such as:
- a change in the structure of the heart that affects how it works and how blood reaches the rest of the body
- gastroschisis, a hole near the belly button that allows the intestines to protrude outside the body
- neural tube defects, which are anomalies that involve the brain, spinal cord, and spine
Sudden infant death syndrome
This is the unexpected death of a baby under the age of 1 year. In most cases, sudden infant death syndrome (SIDS) occurs when the baby is sleeping. If a pregnant person uses opioids, it increases the baby’s risk of SIDS.
Opioid addiction can happen to anyone. Some signs that opioid use may be problematic include:
- having strong cravings or desire for an opioid
- taking more than a doctor prescribes
- feeling like stopping may not be possible
- needing a higher dose to get the same effect
- spending time getting and using opioids
- having problems at home, school, or work as a result of opioid use
- feeling unwell when stopping or reducing opioid use
If a person is experiencing any of these things, they may have opioid use disorder (OUD).
This health condition can make it difficult to take care of oneself because getting and using opioids becomes increasingly important. People with OUD are also at risk of other conditions, such as:
- HIV or hepatitis C, if a person shares needles with others
If someone has taken opioids during pregnancy, a doctor should know:
- what the opioid was
- how often the person took it
- whether they took it with other drugs or alcohol
In some situations, it may not be necessary to take further action. If a person only took an opioid once or twice, the doctor may continue to monitor the person’s health.
If opioid use is or was frequent, they can develop a treatment plan that helps the person stop taking opioids or switch to a less dangerous method of pain relief. It is essential to do this with medical supervision, as rapid opioid withdrawal has its own risks.
If a person has overdosed, immediately dial 911 or the number of the nearest emergency department. The symptoms of an opioid overdose include:
- floppy limbs
- cold, clammy skin
- blurry vision
- feeling faint or dizzy
- feeling sleepy or unable to stay awake
- slowed breathing or heartbeat
During pregnancy, doctors can begin treatment for OUD. This may involve opioid replacement therapy.
Opioid replacement therapy involves taking a long-acting opioid, such as methadone or buprenorphine. These drugs do not cause a euphoric “high” and stay in the body for longer periods than other opioids. Over time, this reduces the body’s need for opioids.
If a person takes this treatment, their baby may still experience some withdrawal symptoms, but the risk of other complications is lower. It is safe to breastfeed a baby who has NAS because any opioids in breast milk may ease the withdrawal as the baby’s body adjusts.
Pregnant people with OUD may also be able to take a medication known as naloxone (Narcan), which can help stop the damaging effects of opioids. Larger doses are potentially lifesaving in cases of overdose, but some people may be able to take smaller doses during pregnancy, too. Ask a doctor about this option.
Another part of treatment for opioid misuse is behavioral therapy. It can help change the person’s feelings about the drug and help them learn other coping mechanisms. It also aims to help a person avoid or manage any situation that might lead to a relapse.
Opioids are a group of drugs that doctors prescribe for severe or chronic pain. They are highly addictive.
Using opioids during pregnancy can harm the person and their fetus in many ways and increase the risk of complications, including pregnancy loss.
However, suddenly stopping opioids can also be dangerous. For anyone who takes an opioid during pregnancy, it is vital to speak with a healthcare professional, who can determine the best course of action and develop a treatment plan.