Is Morphine Safe to Use During Pregnancy?

Experiencing discomfort during pregnancy, labor, and the postpartum phase is a common struggle. As your body undergoes significant changes, you may encounter various aches and pains, even without any complications. Consequently, you might be wondering if pain medications like morphine are safe for use during pregnancy.

For some pregnant individuals, complications can exacerbate pain levels, while others may endure severe or chronic health conditions. Research indicates that chronic conditions affect approximately 15% of pregnancies. Moreover, about 1 in 1,000 pregnancies occur alongside a cancer diagnosis each year.

Managing pain during pregnancy can be challenging due to the potential risk of medications crossing the placenta and affecting the fetus. While healthcare providers may occasionally recommend morphine for severe pain management, the safety of this opioid for developing babies remains uncertain. In this article, we will discuss the safety of morphine during pregnancy and explore the associated risks for both you and your baby.

Can You Take Morphine While Pregnant?

Healthcare professionals sometimes prescribe morphine to treat severe pain during pregnancy, mainly due to a lack of effective alternatives. The Centers for Disease Control and Prevention (CDC) highlights the risks associated with other pain relief options, such as ibuprofen, which has been linked to potential birth defects.

As a general guideline, maternal and fetal health experts discourage using morphine during pregnancy unless absolutely necessary, favoring alternative treatments like physical therapy or non-opioid pain relief methods. The American College of Obstetricians and Gynecologists (ACOG) also supports the use of medications specifically designed to treat opioid addiction and dependency in pregnant individuals.

Opioid Usage Among Pregnant Individuals

The CDC reports a staggering 131% increase in opioid use among pregnant women between 2010 and 2017. Approximately 7% reported using prescription opioids such as morphine, while 1 in 5 admitted to misusing these medications.

Potential Risks of Morphine Usage During Pregnancy

Using morphine during pregnancy can increase the risk of birth defects compared to non-opioid pain relievers such as acetaminophen. Categorized as Type C by the Food and Drug Administration (FDA), morphine usage during pregnancy requires a careful assessment of potential benefits versus risks. Prolonged use escalates the risk to category D, indicating definite fetal risks.

Understanding Morphine

Morphine, derived from the opium plant, is a natural narcotic commonly used to relieve severe pain. Although effective, opioids including morphine can lead to dependency and have several side effects such as:

• Oversedation
• Cough suppression
• Respiratory issues
• Mood alterations
• Allergic reactions

Why Is Morphine Prescribed?

Healthcare professionals prescribe morphine mainly for severe pain unmanageable by other therapies. It may be administered in various forms, including:

• Orally (pill or liquid)
• Intramuscular injection
• Intravenous infusion

In intravenous form, which is often utilized during labor, morphine can provide quick relief within minutes, typically lasting about four hours. Additionally, morphine may also be used to address:

• Opioid dependence
• Chronic cough
• Shortness of breath
• Digestive issues
• Severe diarrhea

Managing Pain During Pregnancy

Consulting your healthcare provider about effective pain management strategies during pregnancy is vital, including over-the-counter medications. According to the FDA:

• 6% of individuals are exposed to opioids during pregnancy.
• 18-25% report using ibuprofen.
• 65-70% utilize acetaminophen.

While acetaminophen has generally been deemed safe, newer studies suggest potential risks. Conversely, ibuprofen has been associated with birth defects, especially in the first trimester, and morphine usage brings added concerns in the late stages of pregnancy.

Specific Risks Associated with Morphine Usage

Morphine can cross the placenta, posing various risks to the fetus, particularly with long-term use. Pregnant individuals may face typical side effects along with additional complications such as:

• Drowsiness
• Difficulty breathing
• High blood pressure
• Constipation
• Placental issues
• Preeclampsia
• Miscarriage
• Stillbirth
• Preterm birth

If You Were Taking Morphine Before Pregnancy

If you began morphine or an opioid regimen prior to pregnancy, do not abruptly discontinue usage. Consult your healthcare provider to explore a gradual tapering approach to avoid withdrawal symptoms.

Concerns for Babies Exposed to Morphine

Taking medication during pregnancy involves inherent risks. Limited data exists regarding specific dosages and safety timelines for morphine. However, general fetal development knowledge indicates:

• First trimester: Increased risk for congenital defects.
• Second trimester: More concerns for fetal growth.
• Third trimester: Potential for growth delays, respiratory difficulties, or drug dependence at birth.

Common concerns for infants born to mothers using morphine during pregnancy include:

• Cleft lip/palate
• Clubfoot
• Congenital heart defects
• Neonatal dependency
• Growth delays and low birth weight
• Neurological issues such as microcephaly
• Increased risk of Sudden Infant Death Syndrome (SIDS)

Understanding Neonatal Abstinence Syndrome (NAS)

Neonatal Abstinence Syndrome (NAS) arises when newborns have been exposed to specific substances in utero, particularly opioids. Symptoms can be distressing and painful for newborns, including:

• Irritability
• Feeding difficulties
• Respiratory issues
• Seizures
• Skin mottling
• Hyperactivity
• Vomiting and diarrhea

The Rising Rate of NAS

The incidence of NAS has surged alongside the opioid crisis, rising from 1.5 in 1,000 newborns in 1999 to 6 in 1,000 by 2013. Treatment for NAS often involves non-pharmacologic methods, such as:

• Staying with the birthing parent
• Breastfeeding or chestfeeding
• Skin-to-skin contact
• Minimal stimulation

Can You Breastfeed If You Are Taking Morphine?

Morphine can be transmitted through breast milk. However, using morphine briefly in the immediate postpartum period is often considered compatible with breastfeeding. Long-term morphine therapy requires monitoring due to potential risks, including:

• Weight issues
• Sleepiness
• Feeding challenges
• Respiratory difficulties

Long-Term Outlook for Babies Exposed to Morphine

Babies not affected by NAS, who were exposed to short-term morphine during pregnancy, generally have favorable outcomes, barring any other complications. Conversely, infants dependent on drugs may require extensive treatment, with potential long-lasting effects, including:

• Health defects
• Low birth weight
• Premature birth risks
• Developmental and behavioral issues

Conclusion

While healthcare professionals may prescribe morphine for severe pain management during pregnancy and the postpartum period, such use should only occur when all other pain relief methods have been exhausted. It is crucial to weigh the potential risks, such as miscarriage or birth defects, against the necessary pain management. Discuss any pain management concerns with your healthcare provider to ensure both your health and your baby's safety.