It's common for pregnant women to fret about almost everything they put in their bodies, from chocolate to tuna. But two recent studies suggest there's been an uptick in percentage of pregnant women taking opioid painkillers. Which seems troubling.
The New York Times reports that the first study, in the journal Obstetrics and Gynecology, found that the percentage of women enrolled in Medicaid who filled an opioid prescription jumped from 18.5 percent in 2000 to nearly 23 percent in 2007. The study's author knew he'd see "some increase in trend, but not this magnitude." The second, published in Anesthesiology and dealing with privately insured women, found that 14 percent were given opioids while pregnant.
Codeine and hydrocodone were the most commonly taken drugs; women typically took the drugs for less than a week, and it was largely women in the South and "mountain states" partaking:
The differences were stark: In the study of women enrolled in Medicaid, 41.6 percent of pregnant women in Utah were prescribed opioids, and 35.6 percent in Idaho. Oregon had the lowest, at 9.5 percent, with New York at 9.6 percent.
None of the doctors quoted seem panicked, exactly, so much as taken aback. Some worry specifically about the possibility of increased risk of neural tube defects: "Mothers of children with neural tube defects reported more early opioid use – 3.9 percent – than mothers of children without such congenital defects – 1.6 percent." The Times spoke to the director of maternal-fetal meds at University of Mississippi Med Center, who said he wasn't "terribly concerned" but admitted that "we need to avoid using opioid analgesics as the first-line therapy in pregnant patients to the extent possible, because there is potential risk."
Not to mention there seems to be pretty scanty research on pregnancy and prescription drugs in general:
Pregnant women are taking unprecedented numbers of prescription drugs, not just opioids, and the safety risks are often not well understood. "Fewer than 10 percent of medications approved by the F.D.A. since 1980 have sufficient data to determine fetal risk," said Cheryl S. Broussard, a health scientist at National Center on Birth Defects and Developmental Disabilities.
Of course, if you need medicine, you need medicine—that doesn't change just because you get knocked up. But some worry opioids are being prescribed as an easy solution when other alternatives would be less risky. The Times points to the editorial accompanying the study in Anesthesiology, which suggested that for pregnancy ailments like back pain, physical therapy would likely work better, anyway: "Taking an opioid may be viewed as easier 'than more time-intensive use of other therapies,' the editorial said."
Not to mention it's probably cheaper and easier to get insurance to approve.
But there's also just a lack of good painkiller options for pregnant women:
"If the pain is so severe that acetaminophen is not enough, we have no analgesic option besides opioids," said Dr. George Saade, the director of maternal-fetal medicine at the University of Texas Medical Branch in Galveston.
Which is, frankly, kind of shocking. It's not like pain during pregnancy is a new problem. You'd think this would've been on humanity's to-do list, right underneath cures for hangovers and the common cold—which, come to think of it, we haven't handled, either.
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