Pain Relief Medications During Pregnancy: Are They Safe?

March 16, 2023
3 mins read
Pain Relief Medications During Pregnancy: Are They Safe?
Medicine and pragnancy. Young pregnant woman holding pill and glass of water in her hand.

Pregnancy is an exciting time for many expectant mothers. But like many other parts of life, it comes with its challenges. 

One of the most common issues a pregnant woman faces is pain. It can be caused by various factors, some of them not related to the pregnancy itself.  

Pain relief medications are commonly used to alleviate these issues. However, their safety for pregnant women is a matter of concern. As their bodies undergo tremendous change, certain chemical compounds become unsafe not only for them but for their baby as well. 

Here’s a quick breakdown of commonly used painkillers and how they affect pregnancies.

  1. Acetaminophen 

Several painkillers are considered safe to use during pregnancy. The most popular one is acetaminophen. Tylenol is a well-known brand of acetaminophen in the United States, and healthcare providers often recommend it as the first line of treatment for pain relief during pregnancy. However, recent studies have raised concerns of Tylenol as a drug that affects brain development in utero. 

These pinpoint how it’s linked to a higher risk of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children.

Studies on painkiller exposure among pregnant women in England and Canada had similar outcomes. Acetaminophen and over-the-counter painkillers are linked to stillbirth, low birth weight, premature delivery, and increased neonatal admissions.

  1. NSAIDs 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally not recommended during pregnancy. They may increase the risk of miscarriage, premature delivery, and other complications. 

However, these medications may be prescribed in cases where other drugs don’t work or are harmful to the woman and baby. A healthcare team must weigh in before recommending NSAIDs. 

  1. Opioids 

Opioids such as codeine, oxycodone, and hydrocodone are not recommended during pregnancy. 

Codeine is an ingredient in many cough and cold preparations. When not taken as directed, it may cause withdrawal symptoms in the newborn. The risk of addiction in the mother is also a problem.

Meanwhile, alcohol and nicotine can pass through the placental barrier, so withdrawal symptoms may appear when intake ceases abruptly upon birth. The infant may be irritable, feed poorly, vomit, have poor temperature control, experience tremors, and have breathing difficulties. The duration of use and the time since the last intake affects the severity of symptoms.

The Connection Between Acetaminophen, ADHD, And Autism

As mentioned, concerns about acetaminophen and its potential effects have been raised. Several studies have investigated the possible link between maternal use of acetaminophen during pregnancy and the risk of ADHD and autism in children.   

One such study published by JAMA Pediatrics in 2020 analyzed the brain magnetic resonance imaging (MRI) results of children whose mothers used acetaminophen. The researchers found abnormal brain connectivity between the frontoparietal area of the brain and the sensorimotor cortex. This altered connectivity is associated with hyperactivity. 

Another related study in 2017 went through data from over 2,500 mother-child pairs. It found that children whose mothers took acetaminophen were more likely to be diagnosed with ASD than those without exposure to the drug.  

In 2019, a John Hopkins study funded by the National Institutes of Health also suggested a correlation between the level of acetaminophen, specifically Tylenol, in the umbilical cord and the chances of developing ADHD or ASD. Babies with higher levels of the drug in cord blood were found to have a three-fold risk of developing those conditions.  

Two years later, the results were corroborated by a European study on prenatal acetaminophen intake involving around 74,000 parent-child pairs. It showed that children of exposed mothers were 19% more likely to be diagnosed with ASD and 21% more likely to be diagnosed with clinical or borderline ADHD.   

Many scientists and doctors used these results to caution expecting women against using acetaminophen.

Direct Effects of Acetaminophen On Pregnant Women 

Acetaminophen has a toxic metabolic by-product that can cause inflammation and damage if not eliminated quickly. Pregnant women with either liver or kidney concerns should avoid it. Otherwise, they must use it strictly as recommended to prevent the effects of drug toxicity on the organs.  

Some women are allergic to acetaminophen. The symptoms include rashes, itchiness, and in more severe cases, difficulty breathing.  

Furthermore, acetaminophen has drug interactions that can heighten or diminish the effects of other therapeutic drugs. For example, taking acetaminophen with NSAIDs such as aspirin, ibuprofen, and naproxen can increase the risk of gastrointestinal bleeding. Some antibiotics, such as rifampin and isoniazid, can increase the metabolism of acetaminophen, leading to a decrease in its effectiveness. 

The toxicity of acetaminophen is related to the dose taken and the duration of treatment. When taken in large amounts, it can seriously harm the liver, leading to liver failure.  

This condition and others like it will also impact fetal health. Therefore, it’s crucial to use acetaminophen as directed and to avoid taking more than the recommended dose.

Reconsider Your Pain Relief Options

Pain relief medications are often necessary during pregnancy to alleviate discomfort. Though acetaminophen is generally considered safe when used as directed, studies have established a relationship between maternal intake and the higher incidence of ADHD and ASD.

Take it up with your doctor and ask them about other options for pain relief. Knowing more may save you and your baby from harm.


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