Opioid Analgesic Use During Pregnancy Is Associated With Increased Risk for Birth Defects

Infants whose mothers used opioid analgesics prior to or during early pregnancy are more likely to have certain birth defects, including hydrocephaly, spina bifida, and congenital heart defects.

Use of opioid analgesics, including codeine and hydrocodone, just before or during early pregnancy leads to a greater risk for birth defects, according to a study published in the April American Journal of Obstetrics and Gynecology.

“Opioid medications are potent prescription analgesics that are the mainstay for treatment of severe pain,” the authors wrote. “Despite evidence of adverse fetal effects with maternal codeine use and the paucity of data on the effects of maternal use of other opioids, such treatment is often assumed to be safe during pregnancy.”

Cheryl S. Broussard, PhD, from the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities in Atlanta, and colleagues analyzed data from the National Birth Defects Prevention Study. Their study included more than 17,000 infants with birth defects whose mothers reported whether they had taken therapeutic opioid analgesics in any dose, duration, or frequency during one month prior to pregnancy and the first trimester.

Birth Defects Associated With Maternal Opioid Use
“Of the 17,449 mothers of case infants with various included birth defects, 454 (2.6%) reported opioid analgesic treatment,” the authors reported. In addition, of 6,701 control mothers, 2% reported treatment during this time period.

Dr. Broussard and the team of investigators identified 7,724 infants with one or more of 15 different kinds of congenital heart defects. Statistically significant associations were found between opioid use and septal defects, pulmonary valve stenosis, hypoplastic left heart syndrome, and tetralogy of Fallot.

“We also found a significant association between maternal opioid use between one month before and three months after conception with spina bifida … but not with the other neural tube defects (anencephaly or craniorachischisis) studied,” the authors stated.

Among the 66% of exposed women who identified a reason for opioid treatment, 41% cited use with surgical procedures, 34% with infections, 20% with chronic diseases, and 18% with injuries, with the most common medications being codeine, hydrocodone, and oxycodone. However, the investigators noted, “the study does not collect information on medication dose, so we were unable to assess dose-response relationships.”

Implications for Opioid Treatment During Pregnancy
“Consistent with some previous investigations, our study shows an association between early pregnancy maternal opioid analgesic treatment and certain birth defects,” the study authors commented. “This information should be considered by women and their physicians who are making treatment decisions during pregnancy.”

The researchers reported that the prevalence of opioid treatment periconceptionally was 2% to 2.6% among the women in their study, while 5% of women in the general population reported “prescription narcotic drug” use.

“It is critical that health care providers weigh the benefits of these medications along with their potential risks when discussing analgesic treatment options with patients who are or may become pregnant,” the authors concluded.

Infants whose mothers used opioid analgesics prior to or during early pregnancy are more likely to have certain birth defects, including hydrocephaly, spina bifida, and congenital heart defects.

Use of opioid analgesics, including codeine and hydrocodone, just before or during early pregnancy leads to a greater risk for birth defects, according to a study published in the April American Journal of Obstetrics and Gynecology.

“Opioid medications are potent prescription analgesics that are the mainstay for treatment of severe pain,” the authors wrote. “Despite evidence of adverse fetal effects with maternal codeine use and the paucity of data on the effects of maternal use of other opioids, such treatment is often assumed to be safe during pregnancy.”

Cheryl S. Broussard, PhD, from the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities in Atlanta, and colleagues analyzed data from the National Birth Defects Prevention Study. Their study included more than 17,000 infants with birth defects whose mothers reported whether they had taken therapeutic opioid analgesics in any dose, duration, or frequency during one month prior to pregnancy and the first trimester.

Birth Defects Associated With Maternal Opioid Use
“Of the 17,449 mothers of case infants with various included birth defects, 454 (2.6%) reported opioid analgesic treatment,” the authors reported. In addition, of 6,701 control mothers, 2% reported treatment during this time period.

Dr. Broussard and the team of investigators identified 7,724 infants with one or more of 15 different kinds of congenital heart defects. Statistically significant associations were found between opioid use and septal defects, pulmonary valve stenosis, hypoplastic left heart syndrome, and tetralogy of Fallot.

“We also found a significant association between maternal opioid use between one month before and three months after conception with spina bifida … but not with the other neural tube defects (anencephaly or craniorachischisis) studied,” the authors stated.

Among the 66% of exposed women who identified a reason for opioid treatment, 41% cited use with surgical procedures, 34% with infections, 20% with chronic diseases, and 18% with injuries, with the most common medications being codeine, hydrocodone, and oxycodone. However, the investigators noted, “the study does not collect information on medication dose, so we were unable to assess dose-response relationships.”

Implications for Opioid Treatment During Pregnancy
“Consistent with some previous investigations, our study shows an association between early pregnancy maternal opioid analgesic treatment and certain birth defects,” the study authors commented. “This information should be considered by women and their physicians who are making treatment decisions during pregnancy.”

The researchers reported that the prevalence of opioid treatment periconceptionally was 2% to 2.6% among the women in their study, while 5% of women in the general population reported “prescription narcotic drug” use.

“It is critical that health care providers weigh the benefits of these medications along with their potential risks when discussing analgesic treatment options with patients who are or may become pregnant,” the authors concluded.

Infants whose mothers used opioid analgesics prior to or during early pregnancy are more likely to have certain birth defects, including hydrocephaly, spina bifida, and congenital heart defects.

Use of opioid analgesics, including codeine and hydrocodone, just before or during early pregnancy leads to a greater risk for birth defects, according to a study published in the April American Journal of Obstetrics and Gynecology.

“Opioid medications are potent prescription analgesics that are the mainstay for treatment of severe pain,” the authors wrote. “Despite evidence of adverse fetal effects with maternal codeine use and the paucity of data on the effects of maternal use of other opioids, such treatment is often assumed to be safe during pregnancy.”

Cheryl S. Broussard, PhD, from the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities in Atlanta, and colleagues analyzed data from the National Birth Defects Prevention Study. Their study included more than 17,000 infants with birth defects whose mothers reported whether they had taken therapeutic opioid analgesics in any dose, duration, or frequency during one month prior to pregnancy and the first trimester.

Birth Defects Associated With Maternal Opioid Use
“Of the 17,449 mothers of case infants with various included birth defects, 454 (2.6%) reported opioid analgesic treatment,” the authors reported. In addition, of 6,701 control mothers, 2% reported treatment during this time period.

Dr. Broussard and the team of investigators identified 7,724 infants with one or more of 15 different kinds of congenital heart defects. Statistically significant associations were found between opioid use and septal defects, pulmonary valve stenosis, hypoplastic left heart syndrome, and tetralogy of Fallot.

“We also found a significant association between maternal opioid use between one month before and three months after conception with spina bifida … but not with the other neural tube defects (anencephaly or craniorachischisis) studied,” the authors stated.

Among the 66% of exposed women who identified a reason for opioid treatment, 41% cited use with surgical procedures, 34% with infections, 20% with chronic diseases, and 18% with injuries, with the most common medications being codeine, hydrocodone, and oxycodone. However, the investigators noted, “the study does not collect information on medication dose, so we were unable to assess dose-response relationships.”

Implications for Opioid Treatment During Pregnancy
“Consistent with some previous investigations, our study shows an association between early pregnancy maternal opioid analgesic treatment and certain birth defects,” the study authors commented. “This information should be considered by women and their physicians who are making treatment decisions during pregnancy.”

The researchers reported that the prevalence of opioid treatment periconceptionally was 2% to 2.6% among the women in their study, while 5% of women in the general population reported “prescription narcotic drug” use.

“It is critical that health care providers weigh the benefits of these medications along with their potential risks when discussing analgesic treatment options with patients who are or may become pregnant,” the authors concluded.