Prescription opioids during pregnancy

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What are prescription opioids?

Prescription opioids are painkillers (medicine used to relieve pain) your health care provider may prescribe if you’ve been injured or had surgery or dental work. They’re sometimes used to treat a cough or diarrhea. A prescription medicine is one your provider says you can take to treat a health condition. You need a prescription (order for medicine) from your health care provider to get the medicine. Opioids are some of the most common medicines prescribed for pregnant women.

Taking opioids during pregnancy can cause serious problems for your baby. If you’re pregnant or thinking about getting pregnant and taking an opioid, tell your health care provider. You may be able to change to a medicine that’s safer for your baby. You and your provider can weigh the benefits and risks of medicine you take, like opioids, to give you the healthiest possible pregnancy.

These are prescription opioids and some of their common brand names. A brand name is the name given to a product by the company that makes it. 

• Buprenorphine (Belbuca®, Buprenex®, Butrans®, Probuphine®)
• Codeine
• Fentanyl (Actiq®, Duragesic®, Sublimaze®)
• Hydrocodone (Lorcet®, Lortab®, Norco®, Vicodin®)
• Hydromophone (Dalaudid®, Exalgo®)
• Meperidine (Demerol®)
• Methadone (Dolophine®, Methadose®)
• Morphine (Astramorph®, Avinza®, Duramorph®, Roxanol®)
• Oxycodone (OxyContin®, Percodan®, Percocet®)
• Oxymorphone (Opana®)
• Tramadol (ConZip®, Ryzolt®, Ultram®)

There are many other brands of opioids, so if you’re taking any medicine you think may be an opioid or combined with an opioid, tell your provider. For example, some cough medicines contain the opioid codeine.

The illegal drug heroin is an opioid. Fentanyl and other prescription opioids are being made and sold illegally. When used illegally, fentanyl sold on the street often is mixed with heroin or cocaine, which makes it extremely dangerous.

Why are opioids dangerous?

It may be hard for some people to stop using opioids because along with relieving pain, they release chemicals in the brain that can make you feel calm and intensely happy (also called euphoria). Drug addiction is a brain condition that makes you use drugs, even if they’re harmful to you. Addiction affects your self-control and your ability to stop taking a drug. Most people who take prescription opioids can stop using them without getting addicted to them. But using them regularly can make you dependent on them, even if you use them as directed by your provider.

At a preconception checkup before pregnancy or at your first prenatal care checkup, your provider asks you questions about your health. Tell your provider about any health conditions you have and any medicines you take. This includes prescription medicine, over-the-counter (also called OTC) medicines, herbal products and supplements. If you take medicine to treat a medical condition, you may need to switch to medicine that’s safer for your baby. Or your provider may recommend different kinds of treatment that don’t use medicine. And if you need help to quit using addictive drugs, your provider can help you find a treatment program.

When your health care provider gives you a prescription for medicine, he tells you exactly how much to take, how often to take it and how long to take it. If you’re pregnant and using prescription opioids, take them exactly as your provider tells you to. Tell your provider about any opioid or other drug you take, even if it’s prescribed by another provider. If you go to a provider who prescribes you an opioid, make sure she knows you’re pregnant. 

 When you take any prescription medicine:

• Don’t take more than your provider says you can take.
• Don’t take it with alcohol or other drugs.
• Don’t use someone else’s prescription drugs.

What is opioid use disorder?

Addiction to opioids is called an opioid use disorder. You may have an opioid use disorder if:

• You take more opioids than your provider says you can take.
• You have cravings (a strong desire) for an opioid.
• You feel like you can’t stop taking opioids or reduce the amount you take.
• You need more opioids to get the same effect.
• You have problems at home, work or school caused by taking opioids.
• You spend time getting and using opioids.
• You feel sick when you stop using opioids or reduce the amount you take.

If you have opioid use disorder, you’re at risk for overdose. This is when you take too much of a drug. Overdose can slow or stop your breathing. It can cause you to pass out and even die. If you’re using opioids and have any of these signs and symptoms of overdose, call your provider or 911:

• Blurred vision
• Cold, clammy skin
• Feeling dizzy, faint or very sleepy
• Feeling sick to your stomach
• Loose, floppy muscles
• Slowed or trouble breathing or a slow heartbeat

If you have opioid use disorder and you share needles with other drug users, you’re at risk for infections like hepatitis and HIV. Hepatitis is a virus that attacks the liver. HIV stands for human immunodeficiency virus. HIV attacks the body’s immune system that usually helps protect you from infections. You can pass infections like these to your baby during pregnancy. 

If you have opioid use disorder, you may have trouble taking care of yourself during pregnancy. For example, you may miss your prenatal care checkups and not make healthy choices for you and your baby. You’re also at risk for overdose and for mental health conditions, like depression. Depression is a medical condition that causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think and act and can interfere with your daily life. It needs treatment to get better.

Can opioids cause problems during pregnancy and after birth?

Yes. Using opioids during pregnancy can affect your health and your baby’s health. If you’re not pregnant and you’re using opioids, use effective birth control until you’re ready to get pregnant. This can help prevent complications when you do get pregnant. Possible complications linked to opioid use during pregnancy may include:

Birth defects. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works. Birth defects associated with opioid use during pregnancy include:

• Congenital heart defects. These conditions can affect the shape of a baby’s heart, how it works or both.
• Gastroschesis. This is a birth defect of a baby’s belly in which the intestines stick outside the body through a hole beside the belly button.
• Glaucoma. This is a group of eye conditions that damage the optic nerve. If untreated, glaucoma can cause blindness.
• Neural tube defects (also called NTDs). These are birth defects of the brain, spine and spinal cord. Spina bifida is the most common NTD.

Miscarriage or stillbirth. Miscarriage is the death of a baby in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy.

Neonatal abstinence syndrome (also called NAS). NAS is when a baby is exposed to a drug in the womb before birth and goes through withdrawal from the drug after birth. NAS is most often caused when a woman takes opioids during pregnancy. NAS can cause serious problems for a baby, like being born too small and having breathing problems. Even if you use an opioid exactly as your health care provider tells you to, it may cause NAS in your baby. So tell your prenatal care provider about any opioid you take, even if it’s prescribed to you by another health care provider. If another health care provider prescribes you an opioid, make sure she knows you’re pregnant.

Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus (womb) before birth. If this happens, your baby may not get enough oxygen and nutrients in the womb. And you may have serious bleeding. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord.

Preeclampsia. This is a serious condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs and symptoms of preeclampsia include having protein in the urine, changes in vision and severe headaches. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.

Preterm labor and preterm birth. This is labor and birth that happen too early, before 37 weeks of pregnancy. Babies born this early may have more health problems at birth and later in life than babies born full term. Opioids also can cause premature rupture of membranes (also called PROM). This is when the sac around a baby breaks before a woman goes into labor.

Problems with your baby’s growth. These include:

• Fetal growth restriction (also called growth-restricted, small for gestational age and small for date). This is when a baby doesn’t gain the weight she should before birth.
• Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.

Sudden infant death syndrome (also called SIDS). This is the unexplained death of a baby younger than 1 year old. SIDS usually happens when a baby is sleeping. Babies born to mothers who use opioids are at increased risk for SIDS.

How is opioid use disorder treated during pregnancy?

Treatment for opioid use disorder during pregnancy may include:

Opioid replacement therapy, including medication-assisted therapy (also called MAT) or opioid-assisted therapy (also called OAT). For these treatments, your provider prescribes you long-acting opioids, like methadone or buprenorphine, that you take during pregnancy and after your baby is born. Long-acting means the opioids stay in your body for a long time. Methadone and buprenorphine help reduce your need for opioids in a way that’s safe for you and your baby. They don’t make you feel happy or calm the way some opioids do. These medicines can help reduce your baby’s risk for premature birth and growth problems. Your baby may have some withdrawal symptoms after birth.

If you’re in MAT, talk to your provider about a medicine called naloxone (brand name Narcan®). Naloxone helps stop the harmful effects of opioids, and it can save your life if you have an opioid overdose. With your provider’s OK, it’s safe to use during pregnancy in small doses. Your provider may prescribe it as a nasal spray or a shot. If you’re using naloxone, keep it with you at all times. Your provider can show you and your family how to use it if you have signs or symptoms of an overdose.

Behavioral therapy (also called counseling). Your provider may recommend that you meet with a counselor by yourself, with a group or both. Counseling can help you change your feelings about drugs and help you develop healthy life skills. It also helps you learn how to avoid or manage situations that may make you likely to relapse. Relapse is when you go back to using a drug after trying to quit using it. People who get drug counseling are less likely to relapse than people who don’t get counseling.

Is it safe to suddenly quit taking opioids during pregnancy?

No. Quitting suddenly (also called going cold turkey) during pregnancy can cause severe problems for your baby, including death. If you’re pregnant and taking opioids, don’t go cold turkey. Talk to your provider about safe ways to stop taking opioids.

If you’re breastfeeding, is it safe to take opioids?

Breastfeeding is good for both you and your baby. It helps you bond with your baby, and your breast milk helps build your baby’s immunity to protect her from infections. If you baby has NAS, breastfeeding may help make her withdrawal less severe so she needs less medicine and can leave the hospital sooner.

If you’re using prescription opioids for pain relief with your provider’s supervision, you can breastfeed depending on the medicine you take. Some opioids can cause life-threatening problems for your baby. Make sure the provider who prescribes you the opioid knows you’re breastfeeding, and take the medicine exactly as our provider tells you to. Talk to your provider about switching to a safer pain reliever if you take:

• Codeine or medicines that contain codeine
• Hydrocodone
• Meperidine
• Oxycodone
• Tramadol

Pain relievers like ibuprofen (Advil®) or acetaminophen (Tylenol®) are safe to use when breastfeeding.

If you’re in MAT or OAT, you can breastfeed your baby if:

• Your health is stable and you’re no longer abusing opioids or using street drugs, like cocaine or marijuana.
• You don’t have HIV.
• Your MAT or OAT program is supervised and your treatment is closely monitored.
• You have social support from friends and family throughout your treatment.
• Your baby continues to gain weight as you breastfeed.  

Are you at risk forhaving problems with opioids?

We don’t know why some people have problems when they try to stop using opioids and others can stop using them without problems. We do know that some things make you more likely than others tohave problems with opioids. These are called risk factors. Having a risk factor doesn’t mean for sure that you’llhave these problems. But it may increase your chances. Risk factors for addiction include:

• A family history of problems with drugs. These problems are more common in some families. Tell your provider if you have a parent, brother or sister who’s had a problem with drugs or alcohol. Fill out the March of Dimes family health history form to record health information about your family and share the form with your provider.
• A mental health condition. Pregnant women with opioid use disorder often have a mental health condition, like anxiety, depression or post-traumatic stress disorder (also called PTSD). Anxiety is strong feelings of worry or fear, and depression is strong feelings of sadness. These feelings last for a long time and interfere with your daily life. PTSD can happen if you’ve experienced a shocking, scary or dangerous event, like a disaster, rape, abuse or the sudden death of a loved one. People with PTSD may have serious anxiety, flashbacks, nightmares or physical responses (like sweating or a racing heartbeat) when reminded of the event. Tell your provider if you have or think you have a mental health condition, like anxiety, depression or PTSD.
• Peer pressure. If your friends or people around you use drugs, you’re more likely to use drugs and have problems with them.
• Taking drugs that are highly addictive, like opioids

Where can you get help to stop abusing prescription drugs, including opioids?

If you need help to stop abusing prescription drugs, talk to your health care provider, use the Substance Abuse Treatment Services Facility Locator or call (800) 662-4357.

More information

• Food and Drug Administration
• Mother to Baby
• Treating for Two

Last reviewed: June, 2019

See also: Neonatal abstinence syndrome (NAS), Preventing NAS in your baby infographic, Caring for a baby with NAS infographic