Codeine in first trimester

[FirstTimeMumma]

Hi all,

I'm quite concerned and was looking for some advice/reassurance.

I am currently 17 weeks pregnant with my first child. I am a chronic migraine sufferer and before pregnancy was taking 3 or 4 8/500 co-codamol (codeine and acetaminophen) tablets a day. Sometimes I would take up to 6 if the pain was severe but never more than that.

When I found out I was pregnant I asked my doctor about taking co-codamol in pregnancy and he reassured me that there was no evidence that co-codamol was harmful to fetuses and my dosage was so low that it would be very unlikely to cause any problems.

Reassured, I continued to take co-codamol, although I noticed my migraines appeared to improve so most days I was only taking 2 or 3 tablets, sometimes up to 5 if I had a severe migraine.

Thankfully my migraines improved even more once I hit the second trimester, and I haven't needed to take any codeine at all since I was 15 weeks. However, I Googled codeine in pregnancy and was horrified to read that babies can become addicted in the womb and withdraw after birth. Plus I read other things that said it may cause birth defects if taken in the first trimester, but they weren't scientific or medical pages.

If I stopped taking codeine at 15 weeks, is there any chance my baby will still be born dependent on codeine? I am also worried about potential birth defects although most things I've read say there isn't any link.

Any advice/reassurance would be greatly appreciated!

[Sandra]

FirstTimeMumma,

"Codeine is an opioid analgesic used for mild to moderate pain relief and as an antitussive agent.[1] There does not appear to be an increase in the risk of congenital malformations but when given near term can cause neonatal withdrawal and CNS depression in the neonate.[2-5] There have been some reports in human studies regarding the use of codeine during pregnancy and the development of cleft palate, hydrocephaly, cardiac defects, pyloric stenosis, umbilical hernia, and respiratory tract problems. So far, none of these proposed effects of codeine in pregnancy have been confirmed.[6,7,8,9] It is unlikely that the fetus will be affected if codeine is given soon before delivery or after time has been allowed to pass since the administration.[10]"(Medications and Mothers' Milk database, Dr Thomas Hale PhD). If you stopped using the codeine at 15 weeks your infant should not have withdrawal symptoms at delivery.

1.##Kastrup E. Drug Facts and Comparisons 2010: Wolters Kluwer Health; 2010.
2.##Briggs G, Freeman, R., and Yaffe, S. Drugs in Pregancy and Lactation. Vol Seventh Ed. Philadelphia PA: Lippincott, Williams, and Wilkins; 2005.
3.##Khan K, Chang J. Neonatal abstinence syndrome due to codeine. Arch Dis Child Fetal Neonatal Ed. Jan 1997;76(1):F59-60.
4.##Koren G. Medication Safety in Pregnancy and Breastfeeding. McGraw-Hill. Accessed June, 23, 2010, 2007.
5.##Shaw GM, Todoroff K, Velie EM, Lammer EJ. Maternal illness, including fever and medication use as risk factors for neural tube defects. Teratology. Jan 1998;57(1):1-7.
6.##Bracken MB & Holford TR: Exposure to prescribed drugs in pregnancy and association with congenital malformations. Obstet Gynecol 1981; 58:336-344.
7.##Rothman KJ, Fyler DC, Goldblatt A, et al: Exogenous hormones and other drug exposures of children with congenital heart disease. Am J Epidemiol 1979; 109:433-439.
8.##Saxen I: Associations between oral clefts and drugs taken during pregnancy. Int J Epidemiol 1975; 4:37-44.
9.##Heinonen OP, Slone D, & Shapiro SHeinonen OP, Slone D, & Shapiro S: Birth Defects and Drugs in Pregnancy, Publishing Sciences Group, Inc, Littleton, MA, 1977.
10.##Herschel M, Khoshnood B, & Lass NA: Role of naloxone in newborn resuscitation. Pediatrics 2000; 106:831-835.

Sandra Lovato R.N.
InfantRisk Center