Opioid painkillers used before or early in pregnancy doubles birth defect risk

By Kathleen Blanchard

Opioid pain medications, taken early in pregnancy and even just before getting pregnant can double the chances of serious birth defects, find U.S. government investigators. The report, released by the Centers for Disease Control and Prevention (CDC) and published in the American Journal of Obstetrics and Gynecology, highlights the need for women of childbearing age and well as clinicians to remain vigilant about the use of the prescription painkillers.

Though the risk of birth defects is described as “modest” from opioid painkillers that include codeine, oxycodone and hydrocodone, the study found women who took the medications were twice as likely as those who did not to have a baby with a congenital heart defect known as hypoplastic left heart syndrome – underdevelopment of the left side of the heart.

According to the CDC, birth defects occur in 40,000 newborns annually, resulting in significant rates of death in the first year of life and substantial disability for those who survive. The researchers found 2 to 3 percent of mothers had been treated with opioids just before or early during pregnancy.

In the current study, the investigators found opioids were responsible for several types of heart defects in newborns as well as other congenital disorders like spina bifida, hydrocephaly, congenital glaucoma and gastroschisis, a condition manifested by intestinal protrusion from the abdominal wall.

The findings come on the heels of another recent investigation from researchers at Albert Einstein College of Medicine of Yeshiva University that found physician monitoring of opiod prescription drug use is lacking. The study, titled “Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain,” is published March 2 in the “Journal of General Internal Medicine.”

CDC Director Thomas R. Frieden, M.D., M.P.H. says, "Women who are pregnant, or thinking about becoming pregnant, should know there are risks associated with using prescription painkillers.” According to the 2009 National Survey on Drug Use and Health, nearly two million Americans were dependent on or abusing prescription pain relievers, findings that highlight the importance of the current study.

Even though the risk of birth defects from opiod pain medications was found to be modest, Cheryl S. Broussard, Ph.D., CDC's National Center on Birth Defects and Developmental Disabilities says preventing even a small number of birth defect is important, given the seriousness and life-threatening nature of congenital heart defects linked to the pain relievers. Physicians are advised to consider the study results when prescribing medication for women of childbearing age, taking into consideration the possibility of unplanned pregnancy.

Source:

http://www.cdc.gov/media/releases/2011/p0302_opioidbirthdefects.html

Abstract:

http://www.ajog.org/article/S0002-9378(10)02524-X/abstract