Pain is one of the most common complaints during pregnancy. The reasons for pain during the three trimesters are multiple. Some causes of pain are more common during the early stages of pregnancy while others are more frequent during the latter part of pregnancy. The severity and associated features also vary depending on the cause. Painkillers are prescribed to pregnant women for symptomatic relief so that they can feel comfortable. Pregnancy brings about a lot of physiological changes in the body due to the growing fetus; hence any medication is to be prescribed with utmost care. A serious side effect may occur.
Common painkillers used
Pain during pregnancy may occur as a result of some acute infection, injury or due to an associated disease like rheumatoid arthritis. This has to be adequately managed otherwise the patients may go into depression and anxiety due to persistent agony. This can also affect the health of the mother as well as the well-being of the growing fetus. The mother should not suffer as there are multiple options for pain relief during pregnancy. Some of the commonly used painkillers are paracetamol, aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. During the antenatal check-up, the pregnant women are counseled to avoid any self-medication. The aim is to avoid any abortion in the early pregnancy or birth defects. Scientific studies have shown that more than 80% of women use some medication during pregnancy, painkillers being the most common after excluding the nutritional supplements.
Safety of painkillers
The physician has to take an informed decision before giving painkillers to the pregnant lady.
Paracetamol: Paracetamol is used for the relief of pain and fever and is very commonly used. This drug easily crosses the placenta to enter fetal blood circulation. When used incorrect dosage, it does not seem to cause any adverse effects on pregnancy or any birth defects. Paracetamol is the preferred analgesic during pregnancy.
Aspirin: This drug is used to treat mild pain and fever. Its use is not associated with an increased risk of congenital malformations of the fetus though one study pointed out that when used during the first three months of pregnancy, it may result in defects in the abdominal wall of the fetus.
NSAIDs: NSAIDs including ibuprofen, naproxen, indomethacin, and diclofenac are commonly used to treat mild pain and fever. They act by inhibiting the enzyme cyclo-oxygenase at the site of pain. In the growing fetus, cyclo-oxygenase is a dilator of the ductus arteriosus and blood vessels in the lungs. If this enzyme is blocked by NSAIDs, it results in premature closure of the above-mentioned blood vessels and adversely affects the oxygenation of blood after birth due to pulmonary hypertension. Hence these drugs are contraindicated after 30 weeks of pregnancy.
These drugs have not been associated with abortion, preterm delivery, or low birth weight. A clinical study showed that when aspirin and NSAIDs were used simultaneously during the first trimester, the risk of miscarriage increased significantly. High doses of NSAIDs in the third trimester may damage fetal kidneys and decrease fetal urine output.
Opioids: They are used for the treatment of moderate to severe pregnancy-associated pain. Some of the common drugs in this group include codeine, oxycodone, hydrocodone, morphine, pethidine, and tramadol. Generally, these drugs are not associated with birth defects and do not cause any adverse effects of pregnancy like a miscarriage. The main concern about their use during pregnancy is that it may result in drug dependence of the mother and a drug withdrawal syndrome in the newborn child.
Women with persistent pain may require painkillers during pregnancy. They should seek advice from their physician for optimal pain relief. Pregnant women should be reassured that there are safe options to treat pain during pregnancy.
