From the Guidelines
Morphine is generally considered safer than ketorolac during pregnancy, as it poses minimal risk to the fetus when used short-term and at appropriate doses, whereas ketorolac can cause premature closure of the ductus arteriosus and other complications in the third trimester. The use of morphine in pregnancy is supported by its long history of use for pain management during labor, with well-understood effects 1. In contrast, ketorolac, as a non-steroidal anti-inflammatory drug (NSAID), is associated with potential risks to the fetus, particularly in the third trimester, including premature closure of the ductus arteriosus, pulmonary hypertension, and reduced amniotic fluid levels 1.
When considering pain management during pregnancy, it is essential to weigh the benefits and risks of each medication. Morphine, classified as FDA pregnancy category C, can be used when benefits outweigh risks, whereas ketorolac is category D in the third trimester, indicating positive evidence of risk. The American College of Obstetricians and Gynecologists and other organizations recommend using the lowest effective dose of morphine for the shortest duration possible, while avoiding ketorolac in the third trimester whenever possible 1.
Key considerations for pain management during pregnancy include:
- Using the lowest effective dose of medication for the shortest duration possible
- Avoiding ketorolac in the third trimester due to potential risks to the fetus
- Considering alternative pain management options, such as acetaminophen or regional anesthesia, when possible
- Monitoring fetal well-being and maternal health closely when using any medication during pregnancy
- Consulting with a healthcare provider to determine the best course of treatment for individual patients.
From the FDA Drug Label
- 1 Pregnancy Teratogenic Effects (Pregnancy Category C) No formal studies to assess the teratogenic effects of morphine in animals have been conducted. It is also not known whether morphine can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Morphine should be given to a pregnant woman only if clearly needed In humans, the frequency of congenital anomalies have been reported to be no greater than expected among the children of 70 women who were treated with morphine during the first four months of pregnancy or in 448 women treated with morphine anytime during pregnancy
There is no information in the provided drug label about ketoralac. Morphine should be given to a pregnant woman only if clearly needed. The FDA drug label does not answer the question.
From the Research
Comparison of Morphine and Ketoralac in Pregnancy
- Morphine is an opioid, and its use in pregnancy has been studied in various contexts 2, 3, 4, 5.
- Ketoralac is an NSAID, and its use in pregnancy is generally avoided in the third trimester due to established risks 5.
- Short courses of weaker opioids like morphine are generally considered safe in pregnancy, although neonatal abstinence syndrome must be monitored following third trimester exposure 5.
- There is limited safety data available for ketoralac in pregnancy, but NSAIDs as a class are associated with risks in the third trimester 5.
Safety Considerations
- The use of any medication in pregnancy should be carefully considered, weighing the benefits to the mother against the potential risks to the fetus 2, 3, 4, 5.
- Morphine and ketoralac have different safety profiles, and the choice between them should be made on a case-by-case basis, taking into account the individual patient's needs and medical history 5.
- It is essential to monitor for potential side effects and adjust treatment as needed to minimize risks to both the mother and the fetus 2, 3, 4, 5.
Clinical Guidance
- Clinicians should be guided by the available evidence and consider the specific circumstances of each patient when deciding between morphine and ketoralac in pregnancy 3, 5.
- Treatment should be tailored to the lowest therapeutic dose and shortest possible duration, and management should involve a discussion of risks and benefits and monitoring for response 5.
- Further research is required to better understand the safety profile of various analgesics, including morphine and ketoralac, in pregnancy 2, 5.