Pain Management During Pregnancy Warrants Special Consideration

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Many women of reproductive age are taking opioids.
Many women of reproductive age are taking opioids.

In recent months, officials with the CDC released a report that concluded too many women of reproductive age are taking prescription opioids. A separate report noted that the number of newborns displaying signs of opioid withdrawal increased 15-fold in Ontario over a two decade span.

According to Benzon's Book on the Essentials for Pain Medicine and Anesthesia, Second Edition, pain medications are labeled according to category with respect to their risk during both pregnancy and lactation.

Category A medications have shown no increased risk for fetal abnormalities, while categories B through D mean that those medications may not have been thoroughly studied in pregnant women, or not studied at all. Pain medications that are designated Category X have actually had demonstrated fetal abnormalities, and are contraindicated in pregnant women.

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Common pain complaints during pregnancy include leg cramping, back and hip pain, and pain in the ligaments. It is important to rule out more serious causes of pain, for instance, ruling out DVT when a patient complains of leg cramps.

Hydration can be key in dealing with many pains, including back and hip pain and leg cramping. Urging a pregnant women to get proper rest is also important to dealing with pain symptoms during pregnancy. For patients with leg cramps, potassium supplementation is paramount.

Acetaminophen is commonly prescribed to deal with pains commonly reported during pregnancy. This medication is a Category B medication and has not known teratogenic effects. 

In general, NSAIDs have no role for routine pain control in pregnancy, as all NSAIDS are Category D. If NSAIDs are used, it is recommended that they be discontinued by the 34th week of pregnancy.

Opiate medications have a fairly decent track record in pregnancy in terms of teratogenic effects, and as noted in the data from Canada, concerns about withdrawl symptoms in the neonate are warranted, so in the event opioids are used, it is recommended their use be maintained, including methadone.

Regarding benzodiazepine use, the data are conflicting, but these medications have been linked with  congenital heart disease in the neonate. Therefore, it is prudent to withhold these medications in pregnant patients if possible,.

Local anesthetics may be used for various pain issues in the pregnant patient, however it should be noted that lidocaine, septacaine or articaine are Category C.

Given recent reports of overuse of opioids in reproductive age women and withdrawl symptoms reported in some newborn babies who were exposed to opioids in utero, it is important to become familiar with the medications that have the best data on pain relief in pregnant women. Doing so just may save a life.

References

  1. CDC. MMWR. 2015;64(02):37-41.

DISCLAIMER: Dr. Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN.This blog and related podcast is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.

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