Harmful Effects of Analgesic Use during Pregnancy

Stillbirth is a tragic complication of pregnancy, causing emotional, social, and economic disruptions. Various factors, such as advanced maternal age, smoking, obesity, comorbid conditions, poor financial status, and drug use during pregnancy, can contribute to stillbirth. 

Analgesics are associated with a two-fold increased risk of stillbirth. However, the evidence linking analgesic use to stillbirth is not conclusive. The misuse of over-the-counter analgesics is a common problem, and these drugs can harm the fetus when they cross the placental barrier. 

Pregnant women may use analgesics to alleviate pregnancy-related discomfort, often without medical supervision. This irrational analgesic use, especially during the second and third trimesters, poses a significant risk of stillbirth. NSAIDs and paracetamol are available over-the-counter; these drugs must be avoided during the third trimester. Opioid analgesics, such as morphine and methadone, pose significant risks to both mother and fetus, including teratogenic effects.

During pregnancy, changes in plasma volume and drug absorption increase the bioavailability of free drugs, allowing them to cross the placenta. NSAIDs crossing the placenta can lead to kidney injury in the developing fetus, causing oligohydramnios and potential cord injuries, increasing the risk of stillbirth. Opioid use during pregnancy is associated with obstetric and perinatal problems, including an increased risk of stillbirth, and may lead to dependency. Opioids can enter the fetus's system, causing respiratory distress, growth limitation, placental abruption, and early uterine contractions, resulting in fetal injury and death. Studies have shown a significant association between stillbirth and opioid exposure during pregnancy.

In India, analgesic misuse during pregnancy is prevalent due to a lack of awareness about their fetal adverse effects. To address this issue, it is crucial to promote rational analgesic use by educating pregnant women about the potential risks and involving registered pharmacists to ensure responsible dispensing with prior medical authorization.

Source: Girish B S, Johns J M, Meghana C S, Rakshitha H R, Nekkanti V. Indian J Obstet Gynecol Res. 2023;10(1):1-6