Doctors are prescribing opioid painkillers to pregnant women in astonishing numbers despite the fact that risks to the developing fetus are largely unknown. This is just insane. As if this country doesn’t have enough of a drug problem. Government statistics show that of the 1.1 million pregnant women enrolled in Medicaid nationally, nearly 23 percent filled an opioid prescription in 2007 according to a study published in Obstetrics and gynaecology. Think of that number: One in five women using opioids during pregnancy.
When a woman goes through pregnancy, doctors monitor every aspect to make sure that harmful foods such as caffeine, sushi and even cold cuts don’t affect the fetus. The health of the fetus is the most important aspect of their jobs. I am amazed to see such a high use of narcotics in pregnancy but yet women worry about a cup of coffee.
The opioids most prescribed during pregnancy were codeine and hydrocodone. Oxycodone was in the top four. The opioid prescriptions were highest in the South and mountain states but lowest in the Northeast. It’s hard to imagine that pregnant women in the South have that much more pain than pregnant women in the Northeast. Pregnant women are taking unprecedented numbers of prescription drugs, not just opioids, and the safety risks are often not well understood.
Pregnant or not, Americans are simply pain-averse. You can’t tell a patient it’s normal for you to be uncomfortable in pregnancy. They just don’t want to hear it but want an immediate resolution to the pain.
But opioids in particular are beginning to worry scientists and doctors. Although not definitive, recent studies have suggested a modest association between first trimester use of opioids and birth defects. Opioid use in very early pregnancy is associated with an approximate doubling the risk of neural tube defects. Neural tube defects occurs when the head end of the neural tube fails to close resulting in an absence of a major portion of the brain and skull. Infants born with this condition are born without the main part of the forebrain and are usually blind, deaf and unconscious. At the end of pregnancy, prolonged use also can lead to addiction in both mothers and their infants, a problem known as “neonatal abstinence syndrome.
The reasons behind the surge in opioid use are unclear. Pregnancy has always entailed discomfort. A growing baby may place pressure on the mother’s nerves. Weight gain, posture changes and pelvic floor dysfunction all can result in discomfort and pain for mothers-to-be. Prescription drugs are not the answer while acetaminophen might have been a better choice. Nonsteroidal anti-inflammatory drugs like ibuprofen are sometimes used, but there is evidence of increased pregnancy loss in the first trimester and potential risk to the baby in the third
Another theory is obesity. A rise in obesity has increased the frequency of back problems experienced by mothers. In recent studies, opioids were used most often by pregnant women to treat back pain or abdominal pain. I don’t know how much that would help considering that some physical therapy can alleviate those symptoms.
Would you use or allow the use of opioids during pregnancy?