From the Guidelines
Neither Percocet (oxycodone/acetaminophen) nor Norco (hydrocodone/acetaminophen) is considered completely safe during pregnancy, and both should be used only when the potential benefits outweigh the risks. If pain medication is absolutely necessary during pregnancy, Norco may be slightly preferred over Percocet because hydrocodone is generally considered less potent than oxycodone, potentially resulting in less exposure to the fetus 1. However, both medications are FDA Category C drugs (for the opioid components) and should be used at the lowest effective dose for the shortest duration possible. Both medications contain acetaminophen, which is generally considered acceptable during pregnancy when used as directed, but the opioid components (oxycodone in Percocet and hydrocodone in Norco) can potentially cause respiratory depression, withdrawal symptoms, and developmental issues in the newborn if used regularly, especially in the third trimester. Some key points to consider when managing pain in pregnancy include:
- Non-pharmacological pain management strategies should be tried first
- If medication is needed, acetaminophen alone is typically the first-line option for pain during pregnancy
- Any use of opioid medications during pregnancy should be closely monitored by healthcare providers who can balance the mother's need for pain relief against potential risks to the developing fetus 1. It's also important to note that a recent workshop on substance use disorders in pregnancy emphasized the importance of screening for substance use at the first prenatal visit, using nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as first-line treatments for pain, and considering a short course of low-dose opioids only for severe pain that is not managed effectively by nonopioid options 1.
From the Research
Opioid Use in Pregnancy
- The use of opioids during pregnancy has been associated with increased maternal and neonatal morbidity and mortality 2.
- Studies have shown that opioid exposure in pregnancy can lead to adverse perinatal effects, including preterm birth, low birth weight, and small for gestational age infants 2, 3.
Comparison of Opioids
- There is no direct comparison between Percocet and Norco in the provided studies.
- However, studies have compared the use of different opioids in pregnancy, including methadone, buprenorphine, and morphine 4, 5, 6.
- Buprenorphine has been shown to be effective in reducing the duration of opioid treatment and length of stay for neonates with neonatal abstinence syndrome 5.
Safety of Opioids in Pregnancy
- The safety of opioids in pregnancy is a concern, and the benefits of using opioids during pregnancy must be weighed against the risks 4, 3.
- Studies have shown that opioid use in pregnancy can lead to increased odds of maternal death, placental insufficiency, and cardiac arrest 2.
- There is a critical need for research on the effects of opioid use and related pharmacotherapy options in pregnancy 2.