Maternal treatment with opioid analgesics and risk for birth defects

Broussard, Cheryl S.; Rasmussen, Sonja A.; Reefhuis, Jennita; Friedman, Jan M.; Jann, Michael W.; Riehle‐Colarusso, Tiffany; Honein, Margaret A.

doi:10.1016/j.ajog.2010.12.039

Cited by 304 publications

(265 citation statements)

References 30 publications

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“…Considering that opioids have been associated with neural tube defects, cardiac septal defects and the rise in neonatal hospital admissions associated with neonatal abstinence syndrome, our findings raise some concern. [9][10][11][12][13][14] A previous analysis of the overall Canadian population, for the period 2005-2010, showed a similar increase in opioid use of 13.1%. 29 US database studies have also shown increases in opioid use during pregnancy (from the mid-1990s to 2009), but the magnitude of change was generally larger than what we found, with increases in exposure ranging from 0.23-fold to 4.73-fold.…”

Section: Discussionmentioning

confidence: 92%

“…5,6,8 Although the effects of opioid use on the developing fetus are poorly understood and findings are varied, associations with complications, including neural tube defects and cardiac septal defects, have been found. [9][10][11] Neonatal abstinence syndrome, a drug-withdrawal syndrome that most commonly occurs after in utero exposure to opioids, has become one of the fastest growing reasons for neonatal hospital admissions. 11,12 Recent studies of opioid exposure in pregnancy have reported incidences of 4.3 to 5.9 cases of neonatal abstinence syndrome per 1000 births.…”

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confidence: 99%

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Opioid use during pregnancy: a population-based cohort study

et al. 2017

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Background:Opioid use has increased dramatically in North America. The safety of opioids in pregnancy is uncertain, but they are associated with several fetal abnormalities and contribute to rising rates of neonatal abstinence syndrome. We examined opioid use before and during pregnancy in a complete population-based cohort. Methods:We examined opioid use in a cohort of all pregnant women in Manitoba, Canada, from 2001 to 2013. Opioid use was defined by prescriptions for opioids, converted to oral morphine equivalents (MEQ), during the 3 months before pregnancy and for each trimester. Given that the exposure per person may vary (because not all women complete all time periods), we determined a weighted number of pregnancies in each period.Results: During the study period, 174 848 completed pregnancies were eligible for analysis (173 680 live births and 1168 stillbirths and intrauterine deaths), which represented a weighted value of 175 174 pregnancies. Among these pregnancies, 6.7% of the women filled opioid prescriptions in the 3 months before pregnancy. Use declined to 4.2% during the first trimester and further declined to 3.0% and 2.9% in the second and third trimesters, respectively. Over the study period, there was a modest increase in opioid use overall (from 7.3% to 7.7%). MEQ did not decline during pregnancy, and the mean MEQ increased significantly over the study period (from 284 mg to 1218 mg). Prescriptions for codeine were filled by 96.9% of the users, accounting for 66.2% of MEQ.Interpretation: Although many of the women using opioids before pregnancy discontinued or reduced use of these drugs during pregnancy, the volume of opioids consumed by those who continued opioid use did not decline during pregnancy. The increasing dosage and increased use of higher-potency opioids by pregnant women highlights the need for continued evaluation of and education about the benefits and risks of this practice. Abstract ResearchResearch CMAJ OPEN E518CMAJ OPEN, 5(2)

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Section: Discussionmentioning

confidence: 92%

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confidence: 99%

Opioid use during pregnancy: a population-based cohort study

et al. 2017

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“…Although some animal data suggest adverse neurodevelopment outcomes due to opiate exposure in early life, clinical data in humans remains insufficient and inconclusive [4,5]. Nevertheless, the few data available for morphine [6] and codeine [7] do not indicate teratogenic properties when used during the first trimester.…”

Section: Introductionmentioning

confidence: 99%

Use of tramadol in early pregnancy and congenital malformation risk

Källén

Reis

2015

Reproductive Toxicology

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Only few studies exist regarding the risk of a teratogenic effect of tramadol when used in early pregnancy. Using the Swedish Medical Birth Register, women (deliveries in 1997-2013) who had reported the use of tramadol in early pregnancy were identified. Maternal characteristics and concomitant drug use were analyzed. Among 1 682 846 women (1 797 678 infants), 1751 (1776 infants) had used tramadol, 96 of the infants had a congenital malformation and 70 of them were relatively severe. The adjusted odds ratio for a relatively severe malformation was 1.33 (95% CI 1.05-1.70). The odds ratios for cardiovascular defects (1.56, 95% CI 1.04-2.29) and for pes equinovarus (3.63, 95% CI 1.61-6.89) were significantly increased. The study suggests a teratogenic effect of tramadol but the risk increase is moderate.Word count: 128.

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“…Such therapy during pregnancy has been found to be associated with neonatal withdrawal syndrome, poor birth outcome, and certain birth defects. [64][65][66] Because of this, COT during pregnancy is not encouraged unless the potential benefits outweigh the risks.…”

Section: Prescription For Special Concernsmentioning

confidence: 99%