Pregnancy and Chronic Pain
Medications During Pregnancy
Many people with severe and persistent pain depend on a variety of medications to help them carry on with activities of daily life. During pregnancy, however, women who are taking medicines to treat pain or other chronic conditions must work together with their health care providers to ensure their babies are not harmed by such medications. While it is believed that up to 10% or more of birth defects are caused by maternal drug exposure, there is still a lot of misinformation about the effect of medications on developing fetuses. The truth of the matter is that some drugs are perfectly acceptable to take during pregnancy. Others are not.
Below is some basic information regarding toxicity and contraindications of common pain medications. This is not absolute, nor should this be your only guide to finding out if the medications you are on can cause damage. If you are currently taking medications and are pregnant (or trying to become pregnant), talk with your health care provider immediately to discuss the drugs’ possible impact on the developing fetus.
The FDA has published a list of Current Categories for Drug Use in Pregnancy that explains how (and why) drugs are labeled by letter, and what the letter means:
Most medications fall into the “Level C” category, which means there have not been enough studies to decide whether the drug is harmful or not. Expectant mothers must work with their health care providers to weigh the risks and benefits of starting (or continuing) a medication.
Most health care providers agree that certain over-the-counter medications are safe to take during pregnancy. According to the American Academy of Family Physicians, “the most commonly used OTC pain medications are aspirin, acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin), ketoprofen (Orudis), and naproxen (Aleve).” The organization lists acetaminophen as the “pain reliever of choice,” and advises mothers to use ibuprofen, ketoprofen and naproxen with caution and to avoid all three in the third trimester. In addition, aspirin is not recommended during pregnancy. Please consult the organization’s web site for more information.
Also note that the FDA’s web site provides Drugs@FDA, a searchable database of medications and information about their safety and efficacy during pregnancy.
Below is some basic information regarding toxicity and contraindications of common pain medications. This is not absolute, nor should this be your only guide to finding out if the medications you are on can cause damage. If you are currently taking medications and are pregnant (or trying to become pregnant), talk with your health care provider immediately to discuss the drugs’ possible impact on the developing fetus.
The FDA has published a list of Current Categories for Drug Use in Pregnancy that explains how (and why) drugs are labeled by letter, and what the letter means:
| Category | Description |
| A | Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities. |
| B | Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate and well-controlled studies in pregnant women. |
| or | |
| Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus. | |
| C | Animal studies have shown an adverse effect and there are no adequate and well-controlled studies in pregnant women. |
|
or
|
|
| No animal studies have been conducted and there are no adequate and well-controlled studies in pregnant women. | |
| D | Studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk. |
| X | Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product contraindictated in women who are or may become pregnant. |
Most medications fall into the “Level C” category, which means there have not been enough studies to decide whether the drug is harmful or not. Expectant mothers must work with their health care providers to weigh the risks and benefits of starting (or continuing) a medication.
Over-the-Counter Medications
Most health care providers agree that certain over-the-counter medications are safe to take during pregnancy. According to the American Academy of Family Physicians, “the most commonly used OTC pain medications are aspirin, acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin), ketoprofen (Orudis), and naproxen (Aleve).” The organization lists acetaminophen as the “pain reliever of choice,” and advises mothers to use ibuprofen, ketoprofen and naproxen with caution and to avoid all three in the third trimester. In addition, aspirin is not recommended during pregnancy. Please consult the organization’s web site for more information.
Also note that the FDA’s web site provides Drugs@FDA, a searchable database of medications and information about their safety and efficacy during pregnancy.