
Acetaminophen with codeine is a medication used to treat pain or cough. It is generally advised to consult a healthcare provider before taking this medication during pregnancy as it may carry certain risks for the fetus. Studies suggest that opioids like codeine can cause physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. Prolonged use of opioids during pregnancy can also result in respiratory depression in the newborn infant. Additionally, there are suggestions that acetaminophen use during pregnancy may be associated with autism spectrum disorder or attention-deficit/hyperactivity disorder in children. However, many OB/GYNs and associations reassure patients that acetaminophen is safe to take during pregnancy and that the benefits likely outweigh any known risks.
What You'll Learn
- Acetaminophen/codeine may cause neonatal abstinence syndrome in the baby
- Prolonged use of opioids during pregnancy can result in physical dependence in the neonate
- Codeine use during pregnancy may cause postpartum hemorrhage
- Codeine use during pregnancy may cause acute Cesarean delivery
- Codeine use may affect future behaviour or learning for the child
Acetaminophen/codeine may cause neonatal abstinence syndrome in the baby
Acetaminophen/codeine may cause neonatal abstinence syndrome (NAS) in the baby. NAS is a potentially life-threatening illness associated with significant morbidity, especially in the neonatal period. It is caused by the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. The incidence of NAS is increasing, along with the length of hospital stays and the need for pharmacological therapy.
Signs of NAS usually manifest within 72 hours of birth, with severity depending on the drug exposure. Initial intervention for NAS starts with supportive care, which may be sufficient for mild withdrawal symptoms. This includes keeping the infant in a dimly lit, quiet environment, tightly swaddled, with minimal interruptions between feedings.
NAS can be life-threatening and can occur without arousing suspicion before the onset of symptoms. Babies born to mothers with substance abuse problems are at an increased risk of adverse neurodevelopment, particularly cognitive and psychomotor deficits.
Acetaminophen (paracetamol) and codeine, an opioid derivative, both cross the placenta. While acetaminophen has been used in humans without apparent harmful effects, codeine has been linked to neonatal abstinence syndrome when used by the mother over a period of several days close to term. Codeine use during pregnancy has also been associated with an increased risk of acute and planned Cesarean delivery and postpartum hemorrhage.
The CYP2D6 gene determines the rate of metabolism of codeine, and individuals are categorised into poor, extensive, and ultrarapid metabolizers. In women who are ultrarapid metabolizers of codeine, higher-than-expected levels of morphine may be present in breast milk, which can lead to dangerously high serum morphine levels in their breastfed infants.
The use of codeine during labour may cause respiratory depression in the newborn infant, and prolonged use of opioids during pregnancy can result in physical dependence in the neonate. The onset, duration, and severity of NAS and neonatal opioid withdrawal syndrome will vary based on the duration of use, timing, amount of last maternal use, and rate of elimination in the newborn.
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Prolonged use of opioids during pregnancy can result in physical dependence in the neonate
The American College of Obstetricians and Gynecologists (ACOG) recommends opioid agonist pharmacotherapy as the preferred treatment for pregnant women with opioid use disorder. This involves the use of medications such as methadone or buprenorphine to prevent opioid withdrawal symptoms and reduce the risk of relapse. It is important to note that opioid agonist pharmacotherapy does not prevent neonatal opioid withdrawal syndrome, and close monitoring of the newborn is necessary.
The onset of neonatal opioid withdrawal syndrome typically occurs within 72 hours of birth but can vary depending on the type of opioid used. For example, symptoms of withdrawal from heroin typically occur within 24-48 hours, while withdrawal from buprenorphine may take 36-60 hours, and methadone can take up to 5 days due to its long half-life.
The treatment approach for neonatal opioid withdrawal syndrome typically involves both non-pharmacologic and pharmacologic interventions. Non-pharmacologic interventions include creating a soothing environment with minimal stimulation and frequent feeding to promote growth. Pharmacologic interventions, such as the use of morphine or methadone, are often required to manage symptoms.
It is important to note that breastfeeding is generally encouraged in women who are stable on opioid agonists and are not using illicit drugs. Breastfeeding has been associated with a decrease in the incidence and severity of neonatal opioid withdrawal syndrome.
The long-term effects of opioid exposure during pregnancy on child development are not yet fully understood, and more research is needed in this area. However, there is some evidence to suggest that opioid-exposed children may be more likely to have attention deficit disorders and disruptive behaviour.
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Codeine use during pregnancy may cause postpartum hemorrhage
Prolonged use of opioids during pregnancy can result in physical dependence in the neonate and neonatal opioid withdrawal syndrome shortly after birth. Opioids, including codeine, cross the placenta. The use of opioids during pregnancy has been found to increase the chance of pregnancy-related problems including poor growth of the baby, stillbirth, preterm delivery (birth before week 37), and the need for a C-section.
Codeine use during pregnancy has been associated with an increased risk of postpartum hemorrhage (heavy bleeding after delivery). A study on 315,085 pregnancies concluded that preeclampsia was significantly associated with postpartum hemorrhage. It is also known that opioid analgesics administered during labor in the form of epidural analgesia are implicated in uterine atony. Failure or weakening of myometrial contractions may result in excessive postpartum hemorrhage as well as Cesarean delivery.
In a large population-based cohort study, codeine use anytime during pregnancy was associated with an increased risk of postpartum hemorrhage (adjusted odds ratio (OR) 1.3, 95% confidence interval (CI) 1.1–1.5, P < 0.0001). Third-trimester use was also associated with an increased risk of postpartum hemorrhage (adjusted OR 1.3, 95% CI 1.1–1.5, P < 0.0001).
While the association between codeine use and postpartum hemorrhage may justify a certain level of caution, it is important to note that the decision to use codeine during pregnancy should be made after consulting a healthcare provider and considering the benefits and risks.
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Codeine use during pregnancy may cause acute Cesarean delivery
Codeine use during pregnancy may be associated with an increased risk of acute Cesarean delivery, according to some studies. In a large population-based cohort study, researchers compared pregnancy outcomes of women who used codeine during pregnancy with those who did not use any opioids. The study found that codeine use at any time during pregnancy was associated with a higher risk of acute Cesarean delivery, with an adjusted odds ratio (OR) of 1.3 and a 95% confidence interval (CI) of 1.1-1.5. This means that women who used codeine during pregnancy had a 30% higher likelihood of having an acute Cesarean delivery compared to those who did not use opioids. The association between codeine use and acute Cesarean delivery was stronger in the third trimester, with an adjusted OR of 1.5 and a 95% CI of 1.3-1.8.
The study also found that codeine use during pregnancy was associated with a higher risk of planned Cesarean delivery and postpartum hemorrhage, but there was no significant impact on infant survival or congenital malformation rates. However, it is important to note that codeine use during labor may cause respiratory depression in the newborn, and prolonged opioid use during pregnancy can result in physical dependence and withdrawal syndrome in the neonate. Therefore, the benefits and risks of using codeine during pregnancy should be carefully considered, and alternative pain management options may be preferred.
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Codeine use may affect future behaviour or learning for the child
While there is no evidence of a direct causal link between codeine use during pregnancy and future behavioural or learning problems in the child, some studies have found an association between the two. These studies have shown that opioid exposure during pregnancy may lead to an increased chance of developmental delay, memory issues, and autism-like features in children. However, it is important to note that these studies have not been able to definitively establish that medication exposure is the cause of these problems, as other factors could also be at play.
The effects of codeine on pregnancy outcomes have been studied, with some research suggesting a possible small increased chance of birth defects such as spina bifida, intestinal problems, and heart issues. However, these studies have not found a specific pattern of birth defects caused by codeine or opioid use. Overall, the risk of birth defects associated with codeine use during pregnancy is likely to be small.
It is important to note that the benefits of treating a condition with codeine during pregnancy may outweigh the potential risks. Therefore, it is crucial to consult with a healthcare provider before making any changes to medication during pregnancy.
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Frequently asked questions
It is not recommended to take acetaminophen with codeine during pregnancy unless the benefits outweigh the risks to the foetus. Prolonged use of opioids during pregnancy can result in physical dependence in the neonate, and neonatal opioid withdrawal syndrome shortly after birth.
It is important to talk to your healthcare provider about alternatives and they can advise on the benefits of treating your condition and the risks of untreated illness during pregnancy.
Studies have found an increased chance of pregnancy-related problems including poor growth of the baby, stillbirth, preterm delivery, and the need for a C-section. It might also cause postpartum haemorrhage (heavy bleeding after delivery) for some people.
Use or misuse of opioids, including codeine, may cause changes to a person's menstrual cycle, making it harder to get pregnant.
The United States Food and Drug Administration (FDA) recommends that codeine is not used during breastfeeding. Codeine passes into breast milk and may cause serious adverse reactions in breastfed infants such as excess sleepiness, difficulty breastfeeding, and serious breathing problems that may result in death.