Tramadol in Pregnancy

Tramadol in Pregnancy

Tramadol in Pregnancy, Benefits & Health Risks

What is Tramadol?

Tramadol (Ultram) is known as tramadol hydrochloride, an opioid prescription drug (analgesic) for moderate to severe pain as well as chronic pain when weaker pain relievers are no longer effective. Tramadol functions by blocking the pain signals that travel along the nerves to the brain to relieve pain. Its most common side effects are dizziness, nausea, and vomiting when used as prescribed.

A person who abuses this pain medication may not necessarily be addicted to the drug. However, the presence of both a physical and psychological dependence on Tramadol typically indicates an addiction. For instance, tolerance and withdrawal symptoms are signs of physical dependence on this drug. In addition, craving for Tramadol is an overall sign of psychological dependence. Alcohol and Tramadol interactions combine the dangers of both and result in intensified consequences for the user.

Tramadol in Pregnancy
When it comes to individuals who suffer from drug dependence, central genesis, liver dysfunctions and increased sensitivity to opioid components, treatments with this drug should be avoided.

Although Tramadol has a low potential for dependence (when compared to morphine), it can still happen when used for prolonged periods. In 2014, Tramadol went from being viewed as a drug of concern to a Schedule IV controlled substance by the US Food and Drugs Administration (FDA) [1]. Since tramadol is not licensed for use in pregnancy and lactation, there is limited clinical research on its use in this patient population.  

The U.S. Food and Drug Administration and the manufacturer recommend against the use of Tramadol during breastfeeding [2]. If tramadol is used, monitor infants for increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, and contact a physician immediately if any of these occur.

What are the Benefits of Taking Tramadol in Pregnancy?

Tramadol is a reasonably strong painkiller and sometimes works where other painkillers have not. If you become pregnant while taking tramadol please contact your midwife, GP, or obstetrician as soon as possible. They will review whether tramadol is still needed and ensure that the dose is correct. Please do not stop taking tramadol or change the dose without speaking to a health care professional.

Why Do Pregnant Women Require Pain Medication?

The body undergoes hormonal and physiological irregularities that result in different symptoms during pregnancy. Sometimes the symptoms are trivial and do not require any kind of pain medication. However, there are also times when the pain is quite severe, requiring some kind of action. Here are some reasons why pregnant women may need to take something for the pain:

  • The diameter of blood vessels changes due to the hormonal changes during pregnancy. This results in headaches and migraines. The intensity of these can vary. However, they have been known to be severe enough to warrant some kind of medication for relief.
  • Pressure on the spine caused by a pregnant woman’s expanding fetus can cause backaches that can sometimes become unbearable. Those who are carrying multiples will find this especially relevant in their case.
  • The strength and stability of the ligaments changes as the body try to prepare the pelvis for delivery. This results in a lot of pelvic pain that may sometimes need pain medication.
  • The pregnant woman’s lower limbs have had to deal with a lot of extra weight. This causes pain from all the ligaments and nerves that have been bearing the strain of the baby’s additional weight.

Effects of Tramadol Use in Pregnancy

Tramadol’s side effects in a pregnant person are similar to those in nonpregnant people. These include:

  • Constipation
  • Nausea and vomiting
  • Dry mouth
  • Indigestion
  • Dizziness
  • Vertigo
  • Headache
  • Drowsiness

Can Tramadol Cause Birth Defects During Pregnancy?

Tramadol is associated with adverse side effects for the fetus and newborn, including opioid withdrawal and seizures. However, there is currently not enough research to say whether or not Tramadol can cause serious birth defects in human babies. 

Signs of neonatal (newborn) opioid withdrawal include:

  • Abnormal sleeping patterns
  • Diarrhea
  • High-pitched cries
  • Hyperactivity (greater amounts of energy)
  • Inability to gain weight
  • Irritability
  • Tremors
  • Vomiting

Can Tramadol Cause a Miscarriage?

There are reports of fetal death as well as stillbirths following Tramadol use. At this time, though, there is not enough data to say definitively if this drug can induce miscarriages in humans.

Tramadol in Pregnancy
It should not be used for more than the specific amount of time needed as prolonged use can cause dependency on the drug.

Tramadol in Labor and Delivery

Tramadol is an opioid analgesic, which research links to prolonged labor. Therefore, this drug is not ideal for pain management before or during childbirth.

Tramadol and Lactation

Tramadol is present in breast milk and is generally not recommended for women who are breastfeeding, as it could result in a lethal respiratory depression on the infant(s).

If you plan to breastfeed your baby, talk with your doctor before taking any pain medication, as it could pose life-threatening damage to your baby. Infants exposed to Tramadol through breastfeeding should be monitored for sedation and respiratory depression.

What are the Side Effects of Taking Tramadol While Pregnant?

Here are some of the side effects or complications linked with Tramadol in pregnancy:

Easily Abused


The central nervous system (brain and spinal cord) responds to pain differently because Tramadol changes this aspect, making it very easy to abuse the drug.

Maternal and Fetal Addiction


Due to the opioid components in this medication, it is addictive in nature, something that is very dangerous for babies. If this drug is used repeatedly, there is an increased chance that babies will become dependent on it.

Even after the drug is discontinued, babies will still experience withdrawal symptoms one month after birth. Babies can also experience congenital disabilities or premature births. A few other symptoms include jitteriness, irritability, seizures, and abnormal muscular activity.

Dangerous Combos


If Tramadol is mixed with other medication, it may cause uncontrollable shaking and seizures.

Simply Problematic


Even when taken in the correct dose, Tramadol has been known to cause side effects such as abdominal pain, itchiness, rashes, joint pains, depression, severe headaches, nausea, and more.

Learning and Behavioral Problems


The brain of your baby is developing even until the end of your pregnancy. Therefore, taking medications during pregnancy can have lasting effects on your child’s behavior and learning.

Tramadol and Breastfeeding


Like some other medications, Tramadol can be transferred into breast milk. If babies consume too much of it through breast milk, they are likely to show signs of increased sleepiness, difficulty breastfeeding, sedation, difficulty breathing, and limpness, and will need to see an expert.

Is Tramadol an Opioid or a Nonopioid Analgesic? 

According to Washington Medical Commission [4], Tramadol is now available in more than 100 countries and is the most commonly prescribed opioid worldwide. In the US, tramadol prescriptions more than doubled between 2007 and 2015, becoming the second most prescribed opioid. Is it possible that the primary care, and particularly nonphysician, prescribers responsible for the increase in Tramadol prescribing in the midst of the “opioid epidemic” are prescribing more Tramadol because they don’t think Tramadol is an opioid?

Tramadol is an opioid analgesic with a complex pharmacokinetic and pharmacodynamic profile that can produce dangerous and diagnostically challenging opioid and nonopioid side effects. Further, although approved by the FDA for moderate to severe pain like other opioids, Tramadol’s analgesic efficacy is controversial and the WHO recommends Tramadol on step 2 of its 3 step analgesic ladder, below most other opioids.  

 What are the Risks of Taking Opioids While Pregnant?

Opioid use during pregnancy can affect women and their babies. Women may use opioids as prescribed, misuse prescription opioids, use illicit opioids such as heroin, or use opioids (opioid agonists and/or antagonists) as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy and potential treatment options for opioid use disorder.

Opioid exposure during pregnancy has been linked to some poor health effects for both mothers and their babies. For mothers, opioid use disorder has been linked to maternal death For babies, maternal opioid use disorder or long-term opioid use has been linked to poor fetal growth, preterm birth, stillbirth, and specific birth defects, and can cause neonatal abstinence syndrome [3].

Opioid use during pregnancy can lead to neonatal abstinence syndrome (NAS) in some newborns. NAS is a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth. Signs of withdrawal usually begin within 72 hours after birth and may include the following:

  • Tremors (trembling)
  • Irritability, including excessive or high-pitched crying
  • Sleep problems
  • Hyperactive reflexes
  • Seizures
  • Yawning, stuffy nose, or sneezing
  • Poor feeding and sucking
  • Vomiting
  • Loose stools and dehydration
  • Increased sweating
Tramadol in Pregnancy
Those women who have had to take Tramadol during their late pregnancy will have babies who will need to be kept for observation after birth for any kind of signs of withdrawal.

The signs a newborn might experience, and how severe the signs will be, depend on different factors. Some factors include the type and amount of substance the newborn was exposed to before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to other substances (e.g., alcohol, tobacco, other medications5-8) before birth.

Withdrawal among newborns during the first 28 days of life due to exposure to opioids before birth is called neonatal opioid withdrawal syndrome (NOWS). NOWS occurs after long-term exposure to opioids; therefore, opioids given at the time of delivery do not cause NOWS

Is Tramadol Safe in Pregnancy?

Though there are some medications out there with more serious side effects of dependency due to their higher opioid content, Tramadol is also known to cause addiction and neonatal dependency on the drug. A change in the diameter of the umbilical vessels is caused due to the painkillers, and this will have an effect on the flow of blood to your baby. This is why it is best to stay away from painkillers in general during your pregnancy unless you have no choice but to take them.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in particular are known to cause this problem. If the blood flow is restricted, your baby will not get enough nutrition, which will either result in restrictions in growth and in extreme and unfortunate cases, the death of the child.

So, can you take Tramadol while pregnant? Only if prescribed by your doctor when there is no other choice. It is best to stay away from it as it is not considered safe due to a lack of proper study. In tests done on animals, it showed that Tramadol has the possibility of causing moderate to severe damage in the fetus. Respiratory depression and collapse in the fetus are severe threats, and so the use of Tramadol is strictly forbidden during delivery.

Tramadol Breastfeeding Warnings

The excretion of Tramadol into milk is low and even lower amounts of the active metabolite, O-desmethyl tramadol, are excreted. With the usual maternal dosage, the amount excreted into breastmilk is much less than the dose that has been given to newborn infants for analgesia. Studies in breastfed newborn infants found no adverse effects attributable to tramadol.

However, a death occurred in the 8-month-old breastfed infant of a woman addicted to Tramadol, although breastfeeding exposure alone might not have accounted for the death. Although tramadol is unlikely to adversely affect nursing infants with usual maternal dosages, the U.S. Food and Drug Administration [5] and the manufacturer recommend against the use of tramadol during breastfeeding.

Are there any Alternatives to Taking Tramadol while Pregnant?

There are many non-opioid pain medications that are available over the counter or by prescription, such as ibuprofen (Motrin), acetaminophen (Tylenol), aspirin (Bayer), and steroids, and some patients find that these are all they need. Other people find relief with nondrug therapies that can be used alone or in combination with medications. These include:

Physical therapy – A physical therapist or physician who specializes in physical medicine and rehabilitation may be able to create an exercise program that helps you improve your ability to function and decreases your pain. Whirlpools, ultrasound, and deep-muscle massage may also help.

Acupuncture – You may find relief from acupuncture, in which very thin needles are inserted at different places in your skin to interrupt pain signals.

Surgery – When other treatments aren’t effective, surgery can be performed to correct abnormalities in your body that may be responsible for your pain.

Injections or nerve blocks – If you are having a muscle spasm or nerve pain, injections with local anesthetics or other medications can help short-circuit your pain.

Many patients also find relief from massages and other relaxation techniques, as well as biofeedback, where you learn to control involuntary functions such as your heart rate.

Being prescribed medication like Tramadol in pregnancy, something that has been known to cause some unpleasant side effects, you will have to examine the benefits and disadvantages before deciding on whether it is worth taking the risk. How medications affect your baby is important, and you need to be very careful about what medication you decide to put into your body. If you struggle with an addiction to tramadol, We Level Up NJ can help you find the healing you deserve. Call us today to speak with someone who can answer your questions about rehab and guide you toward a program that meets your needs.

Tramadol in Pregnancy
Before a woman chooses to take opioid pain-relievers like tramadol during pregnancy, the mother’s health must be considered alongside the potential risks to her unborn baby.

Sources:

[1] [5] FDA – https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-restricts-use-prescription-codeine-pain-and-cough-medicines-and

[2] NCBI – https://www.ncbi.nlm.nih.gov/books/NBK501260/

[3] WCA – https://wmc.wa.gov/sites/default/files/public/Newsletter/IsTramadolanOpioid.pdf

[4] CDC – https://www.cdc.gov/pregnancy/opioids/basics.html