Opioids safe during all stages of pregnancy : RCOG review clarifies

The Royal College of Obstetricians and Gynaecologists (RCOG) has released recommendations on the management of pain medication for women during pregnancy and breastfeeding. According to it, Opioids can be taken during all stages of pregnancy, however, its lowest effective dose should be used for the shortest possible time with advice of attending doctors.

The findings support the use of appropriate pain relief options, as advised by NHS guidance.This Scientific Impact Paper from RCOG reviewed existing evidence-based guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) and European Medicines Agency (EMA) on the use of painkillers during and after pregnancy, as well as during breastfeeding.

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Following is the evidence found during review :

• Paracetamol - With its excellent safety profile, paracetamol is widely used as the first line of pain relief drug treatment throughout pregnancy and during breastfeeding.


• NSAIDS - Where possible women should avoid taking NSAIDs before 30 weeks of pregnancy. If needed and based on the advice of a doctor, a woman is encouraged to take the lowest effective dose for the shortest possible duration. After 30 weeks of gestation, women should not take NSAIDs. NSAIDs are safe to use during breastfeeding.


• Opioids - These can be taken during all stages of pregnancy, however, the lowest effective dose of opioids should be used for the shortest possible time, and based on the advice of a doctor or midwife. After giving birth, if a woman experiences more severe pain and is in need of additional pain relief, then opioids can be used but codeine should be avoided when breastfeeding.

“We are concerned about reports of a fall in the number of pregnant women taking up the flu-vaccine this year. Flu can occasionally be serious for pregnant women as it increases the risk of complications, such as bronchitis, a chest infection that can develop into pneumonia. The best way to avoid getting this is to have the flu vaccination. Women who are pregnant should be reassured that current evidence shows the flu vaccine is safe to use.” said Dr. Pat O’Brien, Consultant Obstetrician and Spokesperson for the Royal College of Obstetricians and Gynaecologists.

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The review also highlights the important difference between codeine and dihydrocodeine (DHC) during breastfeeding and emphasizes that DHC is safe to take during breastfeeding but codeine should be avoided. This is important because a number of women may need – in addition to paracetamol and NSAIDs –opioids for the first few days after birth.

The review cautions that the lowest effective dose should be used when taking any pain relief medication – even those bought over the counter – for the shortest possible duration to minimize any potential risks to the mother and baby.

According to Dr. Dina Bisson, Consultant Obstetrician and lead author of the review, pain should be effectively managed appropriately during pregnancy and breastfeeding. Many women may develop headaches, lower back pain, and pelvic pain during pregnancy and breastfeeding, while others may have chronic conditions, where pain management is necessary. If the pain is not adequately managed, this can have a negative impact on a woman’s physical and mental well-being.

As the cold and flu season arrives, the RCOG review also found that it is important to ensure that women are aware that many over-the-counter remedies for coughs and colds may contain paracetamol, and if taken alongside paracetamol may lead to accidental overdose.