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Ongoing Pharmacological Management of Chronic Pain in Pregnancy

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Abstract

The article discusses possible effects of the use of analgesics during pregnancy. It summarizes the pertinent literature and reports some previously unpublished data from the Swedish Medical Birth Register. Most likely the use of analgesics does not cause spontaneous abortion. Only small malformation risk increases are seen after the use of opioids and perhaps non-steroid anti-inflammatory drug (NSAID) use. If possible, the latter should be avoided during the first trimester. If exposure has occurred there is no reason to consider an interruption of the pregnancy. Continued use of analgesics may increase the risk of preeclampsia and of preterm birth, especially valid for opioids. Use of acetylsalicylic acid (ASA) in late pregnancy should be avoided because of the risk of bleeding and (valid also for NSAIDs) premature closure of the ductus arteriosus. A small risk for neonatal abstinence syndrome may exist after the use of opioids for chronic pain, notably during the third trimester and long-lasting effects on child development can possibly occur. For a woman with chronic pain, adequate use of pain killers during pregnancy is needed. It is prudent to avoid ASA and NSAIDs towards the end of the pregnancy, while acetaminophen is an acceptable option all through pregnancy. If continued use of opioids is necessary, the associated risks are low. Triptans can be used for migraine during pregnancy. If possible sumatriptan is preferable to other triptans as data for the latter are largely lacking. Ergots are preferably avoided as not enough data are available.

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Authors and Affiliations

  1. Tornblad Institute, Lund University, Biskopsgatan 7, 223 62, Lund, Sweden

    Bengt Källén

  2. Department of Medical and Health Sciences, Clinical Pharmacology, Linköping University, Linköping, Sweden

    Margareta Reis

  3. Division of Laboratory Medicine, Department of Clinical Chemistry, Skåne University Hospital, Lund, Sweden

    Margareta Reis

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  1. Bengt Källén
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  2. Margareta Reis
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Correspondence to Bengt Källén.

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None of the authors (BK, MR) declare any conflict of interest.

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No special funding was obtained for this study.

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For this type of study format consent is not required. The information from the Swedish Medical Birth Register is taken from the routine analysis of the register content. No ethics committee evaluation has been needed for this as it was part of the responsibility of the National Board of Health and Welfare.

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Källén, B., Reis, M. Ongoing Pharmacological Management of Chronic Pain in Pregnancy. Drugs 76, 915–924 (2016). https://doi.org/10.1007/s40265-016-0582-3

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