|Medication use in pregnancy calls
for careful consideration
(Photo credit: Magnar Kvilhaug)
While accepted professional guidance recommends caution, it is sometimes necessary to use prescription or OTC medication during pregnancy to treat pain. Neglecting to properly treat severe and persistent pain in pregnancy can result in negative outcomes such as depression, anxiety and high blood pressure in the mother.1 Hence our quandary.
In a recent FDA Drug Safety Communication released January 9, 2015 regarding pain management in pregnant women, the FDC had this to say:
The study findings show that mothers who reported any acetaminophen use during pregnancy were more likely to have a child with a diagnosis of HKD, a child using ADHD medication, or report ADHD-like behavior in their children compared to women unexposed to acetaminophen in pregnancy. The association correlates positively with length of exposure.
“This study had a number of methodologic limitations that make the findings difficult to interpret. The authors did not assess overall markers of health, including health care utilization and/or medication utilization in the year prior to and during the index pregnancy, which might make the observed associations incorrect. No information was provided on the acetaminophen strength and number of dosage units taken; therefore, no conclusions can be made regarding a dose-response relationship. The authors also did not assess clinical ADHD diagnoses. Findings from two other observational studies of neurodevelopment in children exposed to acetaminophen during gestation are conflicting; however, neither of these studies specifically assessed ADHD as an outcome.14, 15“
Due to these methodologic limitations and their negative impact on interpreting the findings, the FDA is taking the position that “the weight of evidence is inconclusive regarding a possible connection between acetaminophen use in pregnancy and ADHD in children”.
So until further studies succeed in providing definitive findings on the associated risks of pain medication use during pregnancy, we shall continue to carefully weigh the benefits and risks and proceed with caution when making recommendations. It is a delicate balance.