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Call to limit opioid prescribing during pregnancy

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Prescribing strong painkillers to pregnant women increases the risk of harm to mothers and babies, a leading drug expert has warned.

Nora Volkow, director of the National Institute on Drug Abuse in the US, urged caution when prescribing opioid drugs such as codeine, morphine and methadone to pregnant women.

“Opioids should be reserved for pregnant women with severe pain that cannot be controlled through more benign means”

Nora Volkow

She said a steep increase in the prescribing of opioids during pregnancy was almost certainly to blame for a rise in neonatal abstinence syndrome (NAS) among babies born in the US.

The surge in prescribing has also been linked to an increase in drugs problems among mothers and mums-to-be.

Neonatal abstinence syndrome is a serious medical condition affecting babies exposed to addictive illegal or prescription drugs while in the womb.

Exposure to opioids before birth has been linked to cognitive impairments in children among other problems.

Ms Volkow said these drugs should only be prescribed to pregnant women with severe pain that could not be controlled with other treatments, ideally for a limited time.

“The use of opioids in pregnancy and for breastfeeding women should be avoided”

Janet Fyle

For those where long-term use was unavoidable, such as women being treated for heroin addiction, she said careful monitoring was vital.

“The lack of scientific information on the effects of opioids on fetal brain development, combined with their known association with NAS, indicates that opioids should be reserved for pregnant women with severe pain that cannot be controlled through more benign means, and ideally limited to a short-term use,” she said in the British Medical Journal.

“If long-term use is unavoidable, such as for women in need of buprenorphine or methadone maintenance therapy for heroin addiction, then careful assessment and monitoring should be undertaken to minimise the risk of overdoses, NAS, and misuse,” she added.

The Royal College of Midwives agreed that the use of opioids during pregnancy and by women who were breastfeeding should be avoided.

“There may be circumstances in which a clinician may opt to prescribe opioids for specific conditions to alleviate pain, but this is rare,” said RCM professional advisor Janet Fyle.

“The woman should be informed by the clinician of the effects of opioids to ensure the drug is acceptable to her and its use is kept to the minimum possible,” she added.

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