Is oxycodone (opioid analgesic) safe for pregnant women?

From the Guidelines

Oxycodone should only be used in pregnant women when the potential benefits clearly outweigh the risks and under close medical supervision, with a short course of treatment and a maximum daily dose of 30 mg or 6 5-mg tablets as needed. According to the American Journal of Obstetrics and Gynecology 1, the use of oxycodone in pregnant women is recommended only when pain is poorly controlled, such as when pain is interfering with the woman's ability to mobilize, breastfeed, or care for her baby. The study suggests that non-opioid pain management strategies, including acetaminophen and NSAIDs, should be tried first.

Some key points to consider when using oxycodone in pregnant women include:

• The risks of oxycodone use increase with longer duration and higher doses
• Potential birth defects, particularly with first-trimester use
• Preterm birth and low birth weight
• Respiratory depression in the newborn
• Neonatal abstinence syndrome, which can include irritability, excessive crying, tremors, and feeding difficulties after birth

It is essential to engage in a shared decision-making process with the patient to select the number of opioid tablets to be prescribed, with no more than the equivalent of 20 5-mg tablets of oxycodone, and to provide information regarding the expected duration of pain, risks, and benefits of opioids and alternatives to opioids 1. Any pregnant woman currently taking oxycodone should not stop suddenly without medical guidance, as abrupt discontinuation can cause withdrawal symptoms in both mother and fetus.

From the FDA Drug Label

Prolonged use of oxycodone hydrochloride tablets during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated. Available data with oxycodone hydrochloride tablets in pregnant women are insufficient to inform a drug-associated risk for major birth defects and miscarriage. Prolonged use of opioid analgesics during pregnancy for medical or nonmedical purposes can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth

Oxycodone is not safe for pregnant women due to the risk of neonatal opioid withdrawal syndrome and potential fetal harm. The use of oxycodone in pregnant women may cause:

• Neonatal opioid withdrawal syndrome: a life-threatening condition that requires management according to protocols developed by neonatology experts
• Fetal harm: although available data are insufficient to inform a drug-associated risk for major birth defects and miscarriage, animal reproduction studies have reported neurobehavioral effects in offspring It is recommended to avoid the use of oxycodone in pregnant women unless the benefits outweigh the risks, and to monitor neonates exposed to opioid analgesics during labor for signs of excess sedation and respiratory depression 2, 2.

From the Research

Opioid Use in Pregnancy

• The use of opioids, including oxycodone, during pregnancy has been associated with increased maternal and neonatal morbidity and mortality 3.
• Opioid exposure in pregnancy has been linked to adverse perinatal effects, such as preterm birth, low birth weight, and small for gestational age infants 3.
• The use of opioids in pregnancy can also lead to neonatal abstinence syndrome (NAS), a condition characterized by withdrawal symptoms in newborns 4, 5.

Safety of Oxycodone in Pregnancy

• There is limited research specifically on the safety of oxycodone in pregnancy, but studies suggest that opioid use in general can have negative effects on maternal and fetal health 3, 6.
• The use of oxycodone during pregnancy should be carefully considered and monitored, as it can increase the risk of adverse outcomes for both the mother and the baby 7.
• Healthcare providers should weigh the benefits and risks of opioid use in pregnancy and consider alternative pain management options when possible 4, 7.

Recommendations for Pregnant Women with Opioid Use Disorder

• Pregnant women with opioid use disorder should receive comprehensive care and treatment, including medication-assisted therapy and behavioral counseling 7.
• Nurses and healthcare providers can play a critical role in screening for opioid use disorder, developing positive relationships with patients, and referring them to treatment 7.
• Care for pregnant women with opioid use disorder should be based on values-neutral strategies to promote healthy outcomes for both the mother and the baby 7.