Accutane, valproate, warfarin. These are common drugs that all doctors know to be problematic in pregnancy because they cause birth defects. Drugs that may affect the developing fetus are required by the FDA to carry warnings to caution prescribers regarding their use during pregnancy and in any woman of childbearing age.
For example, the FDA provides a warning for valproate, a seizure medicine that is also used to prevent migraine headaches, that reads as follows:
With regard to women of childbearing age who are not pregnant, valproate should not be taken for any condition unless the drug is essential to the management of the woman's medical condition. All non-pregnant women of childbearing age taking valproate products should use effective birth control. (FDA, 2013)
Because of these warnings, the medical community is aware of the risk of valproate and other drugs, and babies are rarely born with complications from these drugs. Opioids, however, are a different story. Side effects from maternal opioid use (Neonatal Abstinence Syndrome) are now one of the leading causes of newborn admission to neonatal intensive care units (NICU), accounting for up to 20% of NICU admissions in some areas (Tolia et al., 2015). What’s more, women who use opioids during pregnancy are twice as likely to deliver their baby prematurely (Whiteman et al., 2014). Preterm delivery will not only result in admission to the NICU but may also result in other complications of prematurity including physical and developmental complications that will affect the child’s entire life.
Despite the damaging effect opioids have on newborn babies, opioids are commonly prescribed to women of childbearing age. A recent study found that 25% of insured and 33% of Medicaid women of childbearing age received a prescription for opioids in the past year (Ailes, Dawson, Lind, Gilboa, & Frey, 2015).
Considering that oral opioids are no more effective at relieving pain than ibuprofen or acetaminophen (Teater, 2014), the FDA must take a more aggressive stand on the use of opioids in women of childbearing age.
For the sake of these precious lives, I call on the FDA to warn that opioids should not be used in women of childbearing age unless there is a clear indication that the benefits outweigh the risks.
Ailes, E. C., Dawson, A. L., Lind, J. N., Gilboa, S. M., & Frey, M. T. (2015). Opioid Prescription Claims Among Women of Reproductive Age — United States , 2008 – 2012. MMWR, 64(2), 2008–2012.
FDA. (2013). FDA Drug Safety Communication. Retrieved September 7, 2016, from http://www.fda.gov/drugs/drugsafety/ucm350684.htm
Teater, D. (2014). Evidence for the efficacy of pain medications. Itasca, Illinois. Retrieved from www.nsc.org/painmedevidence
Tolia, V. N., Patrick, S. W., Bennett, M. M., Murthy, K., Sousa, J., Smith, P. B., … Spitzer, A. R. (2015). Increasing Incidence of the Neonatal Abstinence Syndrome in U.S. Neonatal ICUs. N Engl J Med, 372(22), 2118–2126. http://doi.org/10.1056/NEJMsa1500439
Whiteman, V. E., Salemi, J. L., Mogos, M. F., Cain, M. A., Aliyu, M. H., & Salihu, H. M. (2014). Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. Journal of Pregnancy, 2014, 1–8. http://doi.org/10.1155/2014/906723