Opiates & Opioids During Pregnancy

It’s important to weigh the risks and benefits of using opioid medications during pregnancy. Your doctor can help you make the best decision for your situation.

Opiate and opioid use in pregnancy is widespread. A study from 2007 found that almost 23% of pregnant women on Medicaid filled a prescription for an opiate during their pregnancy. Illegal opiate use is also thought to be common. Although it is hard to pinpoint how many heroin users are pregnant, about one-third of heroin users are female and 90% are of childbearing age.

It is important to note that the terms opiate and opioid are often used interchangeably. However, there is a small distinction between them. Opiates refer to drugs derived naturally from poppies, such as heroin, morphine and codeine. Opioids, however, refer to natural opiates as well as synthetic or semi-synthetic opiates that are made in a lab. Synthetic or semi-synthetic opioids include fentanyl, tramadol and oxycodone.

Is It Safe To Take Opiates or Opioids During Pregnancy?

Doctors often hesitate to give a blanket statement about whether medications like opioids are safe during pregnancy. Many times, it is a balance between risk and reward. When there is severe pain from certain medical conditions, experts consider opioids to be safer than many alternatives. However, due to the ever-present risk of opioid addiction, opioid overdose, and opioid withdrawal, it is difficult for doctors to claim that opiate use is safe.

Related Topic: Can You Get Addicted to Opioids Using Them as Prescribed?

Doctors usually advise women to use medications wisely during pregnancy and avoid unnecessary drugs. For this reason, opioids are not usually the first choice for pain management while pregnant or breastfeeding. Doctors often advise women to explore other options so that the baby is not exposed to harmful substances. Alternatives to opioids include non-opioid drugs as well as non-drug therapies. A woman should always talk to their doctor before trying any drug or non-drug remedies while pregnant or breastfeeding.

Do you or someone you love have questions or concerns about a pregnancy and don’t know where to turn for help? Get support and answers at the American Pregnancy Association at 1-800-672-2296.

Commonly Prescribed Opioids

Many types of opioids are produced within the United States, and it is possible that a pregnant woman may have access to a variety of opioid drugs. Some are injectables restricted to hospital use, while others are available by prescription at local pharmacies. Opioids include:

• Alfentanil (Alfenta)
• Benzhydrocodone
• Buprenorphine
• Butorphanol
• Codeine
• Dihydrocodeine
• Fentanyl
• Hydrocodone
• Hydromorphone
• Levorphanol
• Meperidine
• Methadone
• Morphine
• Nalbuphine
• Normethadone
• Oliceridine
• Opium
• Oxycodone
• Oxymorphone
• Paregoric
• Pentazocine
• Remifentanil
• Sufentanil
• Tapentadol
• Tramadol

How Long Do Opiates Stay in Your System While Pregnant?

Unfortunately, there is little data regarding how long opioids remain in your system while you are pregnant. Experts know that drugs break down differently during pregnancy due to metabolism changes in a pregnant woman. Due to ethical concerns, however, trials of drug dosing in pregnant women have not taken place. For this reason, it is difficult to know how long an opioid lasts in a pregnant woman’s body. This uncertainty adds to the concerns doctors have about opioid use in pregnancy.

When the Benefit of Opioids and Opiates Outweighs the Risk

Certain urgent medical issues may respond better to opioids, even in pregnant or breastfeeding women. In these cases, the benefit of opiate use may outweigh the risk to the baby. These issues include:

• The baby was delivered by cesarean section: Cesarean deliveries are invasive surgeries and can be painful for the mother to endure without a short course of opioid therapy.
• Kidney stones: The pain from passing a kidney stone may be too great to bear without a short regimen of opioids.
• Sickle cell disease crisis: Sickle cell disease can lead to painful complications that may require temporary opioid therapy to manage.
• Traumatic injury during or after pregnancy: Severe injuries may require short-term opioid treatment to control pain.
• Chronic pain: Intense pain that causes problems with daily functioning may require opioid treatment.
• Medication-assisted treatment, or MAT, for women recovering from opiate abuse: For women who are overcoming an opioid addiction, continuing long-term MAT with methadone or buprenorphine-based regimens during pregnancy can be beneficial to long-term sobriety.

Effects of Using Opiates or Opioids While Pregnant

Experts are cautious about prescribing opioids to pregnant women. Although some studies suggest that there may be an increase in birth defects linked to opioids taken in pregnancy, other studies have disputed those claims. In addition, doctors are concerned about the risk of abuse, addiction and withdrawal in pregnant women and babies.

For these reasons, doctors try to avoid prescribing opioids to pregnant women, with the exception of MAT.

If a pregnant woman is taking MAT to overcome opioid addiction, doctors believe that the benefit of MAT opioids like methadone or buprenorphine outweighs potential risks. Staying on MAT helps increase the chance that:

• Women will have less risk of relapse
• Women will avoid an early birth
• The baby will grow healthily

Opioid-Born Babies

Opioid-born babies are very common. In fact, in the United States, a baby with opioid withdrawal is born every 15 minutes.

Babies with opioids in their bodies at the time of birth are often diagnosed with neonatal abstinence syndrome, or NAS. This condition occurs when a baby goes into withdrawal from the opioids that their mother took during the pregnancy. Babies of mothers who struggle with heroin are particularly susceptible to NAS, with the condition occurring in up to 94% of heroin-born babies.

Symptoms of NAS:

• Tremors
• Seizures
• Being fussy
• Loose bowel movements
• Throwing up
• Poor feeding
• Problems sleeping
• A high-pitched cry

NAS can be treated. Mothers can comfort NAS babies with swaddling, cuddling and skin-to-skin contact. Sometimes, doctors prescribe opioids to babies with NAS. The babies are then slowly taken off the opioids until they are free of both opioids and NAS. Although NAS can occur in babies whose mothers take medication-assisted opioid addiction treatment, the severity of NAS is much less than if the mothers were misusing opioids.

Long-Term Effects on Babies Born Addicted to Opiates or Opioids

Misusing opioids — especially illicit opioids — while you are pregnant may cause serious long-term consequences for your baby. Some of the effects of abusing opioids during pregnancy can include:

• Stillbirth or miscarriage
• Premature birth
• Problems with the placenta
• Fetal growth restriction

Quitting Opioid or Opiate Use While Pregnant

Pregnant women should not stop opioid use abruptly, as doing so increases the chance of withdrawal. Withdrawal is dangerous in pregnancy and can be deadly to the baby. Further, doctors estimate that suddenly stopping opioid use and going into withdrawal puts the risk of relapse over 90%. Instead, the doctor may be able to help a mother arrange rehab and medication-assisted treatment for opioid use.

Rehab is one of the safest ways to quit taking opioids while pregnant. Rehab consists of participating in intense individual and group therapy sessions while healing from opioid addiction. In therapy, you learn to explore why you became reliant on opioids in the first place and learn coping strategies to live an opioid-free life that is safer for both you and your baby.

Pregnancy experts also recommend MAT for those struggling with opioids during pregnancy. With MAT, instead of taking the opioid you normally take, you are prescribed methadone or a buprenorphine-based product to prevent withdrawal symptoms and cravings.

Opioids and Opiates While Breastfeeding

Generally, women who are on opiates can breastfeed if they:

• Are on stable doses of their opioid
• Are not taking illegal drugs like heroin
• Have tested negative for human immunodeficiency virus, or HIV
• Have no other medical reasons to not breastfeed

However, some opioids may be riskier than others for a baby. For example, if a nursing mother takes codeine or tramadol, their baby may be at a higher risk of opioid exposure. Codeine is a morphine precursor. Because some people’s bodies quickly convert codeine to morphine, it is possible to unintentionally pass a high dose of morphine to the baby through breast milk, putting the baby at risk of an overdose.

Women who take illicit street opioids like heroin should not breastfeed. Not only are breastfeeding babies at risk of a heroin overdose, but they are also at risk of toxicity caused by a variety of substances that drug dealers use when cutting heroin.

Talking to Your Doctor About Opioid or Opiate Use

It’s important to be honest with your doctor, especially during pregnancy and breastfeeding. Your doctor may ask you about pain or what kinds of medications you are taking. If you are experiencing pain or are taking opioids, prescribed or not, it is important to trust your doctor and inform them. With accurate information, your doctor can help plan treatments that are safer for both you and your baby. These can include treatments for pain as well as substance abuse.

Alternatives to Opioids and Opiates While Pregnant or Breastfeeding

There are many non-drug alternatives that can help manage pain. These may help a woman stop taking opioids during pregnancy, or they may help her lower the opioid dose she needs to function. Some options include:

• Over-the-counter medications: Non-prescription pain relievers, such as acetaminophen, are non-addictive medications that can help alleviate minor aches and pains. However, it is important to consult with your doctor before taking an over-the-counter drug. Some over-the-counter therapies, such as ibuprofen, may be linked to pregnancy bleeding or the later development of asthma in the child.
• Acupuncture: Acupuncture involves inserting thin needles into the body to relieve pain, and the practice is common in Asia as well as among nurse-midwives. Acupuncture is relatively safe during pregnancy.
• Exercise: Exercise can include a variety of low-impact activities, ranging from walking and swimming to yoga. Exercise has been shown to reduce back pain and pelvic girdle pain in pregnancy.

Planning for Pregnancy if You Take Opioids

Before you get pregnant, it is important to try to find methods for pain relief that do not include opioids. If you are dependent on opioids but are a woman of childbearing age, it is important to seek professional assistance before getting pregnant.

Taking opioids during pregnancy, especially if they are illicit, can lead to a host of health issues for you and your baby. However, receiving treatment for a substance use disorder can greatly reduce the risk of pregnancy complications. Treatment can involve multiple strategies, including detox, rehab and MAT. These treatments can help you recover from an opioid addiction while keeping both you and your baby safe.

Even if you are already pregnant, it is never too late to start preparing a better, opioid-free life for both yourself and your child.

Our caring, compassionate opioid experts at The Recovery Village can help you taper off opioids safely while pregnant, breastfeeding or trying to conceive. Contact us today to learn more about treatment plans and programs that can work well for your situation.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more