8 | VoLUMe 34 | NUMBer 1| feBrUArY 2011 .aust al anp sc b .c m Analgscs and pan ln pgnancy and bastdng Debra Kennedy, Director, MotherSafe, Royal Hospital for Women, and Conjoint Lecturer, School of Women's and Children's Health, University of New South Wales, SydneySummay wmn shuld bassud that pan can btatd dung pgnancy and lactatn and that thy nd nt suunncssaly. ovall, apppatthaputc dss thcmmnly usd analgscs ncludng paactaml, aspn and pds havnt bn asscatd th an ncasd ncdncbth dcts. Thusnn-stdal ant-nlammaty dugs n ththd tmsts nt cmmndd. Untatd psstnt pan can havadvscts thmthand hpgnancy and mn th psstnt pan shuld dally havptmsatn thpan managmnt bpgnancy. Key wrds: cdeine, nn-steridal anti-inflammatry drugs, piids, paracetaml. (Aust Prescr 2011;34:8–10)intductn Pain during pregnancy may be due tacute cnditins such as injury r infectin, r secndary tunderlying medical disrders such as rheumatid arthritis. Pain related tpregnancy can alsccur. Inadequately managed persistent pain can result in depressin and anxiety. These may impact n a wman's physical and psychlgical wellbeing and can ptentially have an adverse effect n her pregnancy. Wmen shuld nt suffer unnecessarily frm pain during pregnancy and lactatin. If used apprpriately, cmmn analgesics such as paracetaml, aspirin, nn-steridal anti- inflammatry drugs (NSAIDs) and piids are relatively safe. In cunselling wmen abut taking medicines during pregnancy it is always imprtant temphasise that all cuples have a backgrund risk f arund 3% f having a baby with a majr birth defect and that apprximately 15% f all recgnised pregnancies end in miscarriage, regardless f any drug expsures. over 85% f wmen use sme medicatin during pregnancy and analgesics are the mst cmmn preparatins used, after vitamins, in all trimesters f pregnancy, with ver 50% f wmen using analgesics during their pregnancy. 1 The risks r therwise f drug expsures need tbe put intthe cntext f this backgrund risk. Wmen and their health prfessinals can then make infrmed decisins and weigh up the ptential risks f treating versus nt treating pain during pregnancy and breastfeeding. Paactaml Paracetaml is the analgesic and antipyretic drug mst widely used in Australia, particularly by pregnant wmen. Althugh it readily crsses the placenta in its uncnjugated frm, in therapeutic dses it des nt appear tincrease the risk fbirth defects r ther adverse pregnancy utcmes. Despite paracetaml's widespread use there are, smewhat surprisingly, nprspective cntrlled studies abut its use in pregnancy. The drug is nt cnsidered tbe teratgenic althugh sme retrspective studies including the US Cllabrative Perinatal Prject fund an increased risk f any cngenital abnrmality and specifically an increase in cngenital dislcatin f the hip in expsed infants. A registry-based study frm Denmark f26 424 children whwere expsed tparacetaml in uteroduring the first trimester fund nincrease in either the specific r the verall rate f birth defects cmpared with unexpsed cntrls. 2 Aspn Aspirin is used ttreat mild pain and fever, and lw-dse aspirin is alsprescribed by sme bstetricians (ften with heparin) treduce the risk f adverse utcmes in pregnant wmen with antiphsphlipid syndrme and recurrent miscarriages. 3 overall, aspirin is nt assciated with an increased risk f cngenital malfrmatins, althugh ne meta-analysis suggested an assciatin between first trimester aspirin use and increased risk f gastrschisis*. 4 NSAiDs NSAIDs including ibuprfen, naprxen, indmethacin and diclfenac are widely used ttreat mild tmderate pain and fever. They are inhibitrs f cycl-xygenase. In the fetus and newbrn, cycl-xygenase is a ptent dilatr f the ductus arterisus and pulmnary resistance vessels. Its inhibitin culd ptentially cause premature clsure f these vessels. These * an abdminal wall defect resulting frm rupture f the amnitic membrane during gut-lp herniatin r, later, due tdelayed umbilical ring clsure
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Analgesics and Pain Relief in Pregnancy and Breastfeeding
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7/27/2019 Analgesics and Pain Relief in Pregnancy and Breastfeeding