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Medication Use and Pain Management in Pregnancy: A Critical Review
Eleanor Black1,2, Kok Eng Khor3,4, Debra Kennedy5,6
1Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia.
Summary
Managing pain during pregnancy requires careful consideration of analgesic risks. Paracetamol and short-term weak opioids are generally safe, but nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in the third trimester.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Pain Management
Background:
- Pregnancy pain management is complex due to potential risks of analgesics to the fetus and mother.
- Lack of clear guidelines necessitates evidence-based recommendations for safe pain relief during pregnancy.
Purpose of the Study:
- To review and assess the safety data of pharmacological and non-pharmacological pain management methods for pregnant individuals.
- To provide evidence-based recommendations for clinicians managing pain in pregnancy.
Main Methods:
- A comprehensive literature search was performed across multiple medical databases.
- Included clinical trials and observational studies were evaluated for quality and bias.
Main Results:
- Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are suitable for mild to moderate pain, with NSAIDs contraindicated in the third trimester.
- Short courses of weaker opioids are generally safe, but neonatal abstinence syndrome requires monitoring after third-trimester exposure.
- Pregabalin, gabapentin, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors show limited but generally reassuring safety data.
Conclusions:
- Clinical decisions on analgesic prescription should be individualized, considering the lowest effective dose and shortest duration.
- Risk-benefit discussions and patient monitoring are crucial for managing pain in pregnant individuals.
- Further research is needed to fully elucidate the safety profiles of various analgesics during pregnancy.
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