Prescription Painkillers: A Cause of Birth Defects
“I learned in my residency that even your grandmother may be pregnant until you see the test results saying she’s not,” says Joshua A. Copel, MD, professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.
That was 30 years ago, said the practicing maternal-fetal medicine specialist. “So the message to doctors giving out medications to women of child-bearing age is to always think a woman could be pregnant and do a pregnancy test first. And women still need to always ask themselves if they could be pregnant before taking narcotics,” Dr. Copel says.
Focus on Opioid Use in Women of Childbearing Age
In their latest findings in ongoing work to reduce birth defects, researchers at the CDC scoured information on women between the ages of 15 and 44, which are considered the reproductive years. Using insurance claim databases — one for Medicaid enrollees and the other for privately insured women of the same age range — they discovered that more than a third of Medicaid enrollees and more than a quarter of privately insured women had been given an opioid prescription each year.
“This new information underscores the importance of responsible prescribing, especially of opioids, for women of childbearing age,” says Jennifer N. Lind, PharmD, MPH, pharmacist and epidemiologist with CDC’s National Center on Birth Defects and Developmental Disabilities. “Because taking these medications early in pregnancy, often before women know they are pregnant, can increase the risk for some birth defects, such as spina bifida, and other poor pregnancy outcomes, such as pre-term birth or low birth weight.”
Opioid Overdoses on the Rise
About 16,000 men and women die of opioid overdoses every year from such drugs as OxyContin, Roxicodone, Percocet, Vicodin, Dilaudid, Lortab, morphine and heroin. Between 2004 and 2010 alone there was a 45% growth in fatal opiate overdoses, according to U.S. Attorney Eric Holder, declaring opiate addiction and deaths a national public health crisis. And by 2011, the CDC illustrated what it called epidemic opiate use: Enough pain pills were prescribed in 2010 to medicate every American adult around the clock for a month.
Apart from opiates, women overall are taking more prescription medicine than they did a generation ago, according to the CDC’s media office. And Copel points out that many other drugs — such as ACE inhibitors, some psychiatric medications, some antibiotics, a form of vitamin A called Accutane, and a number of over-the-counter medications — present risks to a fetus. “The dilemma is that pregnant women can’t use ibuprofen, which is associated with lack of urine output in the fetus, among other things, and closure of one of the essential heart bypasses that get blood to and from the placenta.”
Copel says he recently faced this dilemma with a pregnant patient who needed an emergency tooth extraction. In that case, he said, it was appropriate to prescribe the opiate-containing Tylenol-codeine drug for her two days of pain. “Short-term opiates aren’t unreasonable,” he says.
Painkillers in Pregnancy Vary by Geography
The CDC data from the private insurance claims revealed other details, such as big differences in opiate use based on where a woman lives. Opioid prescription rates for women 15 to 44 were highest in the South and lowest in the Northeast. The Medicaid date showed race/ethnicity differences in opioid use in the 15 to 44 age range was nearly one and a half times higher among white women compared to black or Hispanic women.
Earlier studies have found that opioid use by pregnant women can potentially increase the risk of a baby’s congenital heart damage, significant deficiencies in the neural tubes of a baby’s spine, and defects to the baby’s abdominal wall, the CDC reported. Using these narcotics in very early pregnancy — before a woman may know she’s pregnant — roughly doubles the risk for birth defects to the neural tubes impacting the brain and spinal cord.
There’s also the risk of an unborn baby becoming addicted to the opioid used by its mother during pregnancy, a condition called neonatal abstinence syndrome.
“The number one issue with pregnancy and narcotics for me is abstinence,” Copel says. “The newborns of mothers who’ve taken them throughout the pregnancy will have become addicted and the baby will go through withdrawal.”
The most commonly prescribed opioids among both groups of women studied were hydrocodone (Vicodin), acetaminophen (Tylenol) with codeine and oxycodone (OxyContin). These drugs are commonly prescribed for moderate to severe pain and some cough medicines may also contain them, CDC Director Tom Frieden, MD, said in announcing the findings.
“Women who are pregnant or planning to become pregnant should discuss with their health care provider the benefits and risks of any medication they’re taking or considering,” Dr. Lind says.
By Nancy Wride
Follow Nancy on Twitter at @NWride