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This is the first edition of this paper.
This Scientific Impact Paper reviews existing evidence-based guidance from the Medicines and Healthcare products Regulatory Agency (MHRA) and European Medicines Agency (EMA) on the use of painkillers during and after pregnancy, as well as during breastfeeding.
The findings reflect current NHS guidance on the use of medical pain relief options in pregnancy and during breastfeeding. The paper also recommends that women try non-medical treatments first, such as adequate rest, hot and cold compresses, massage, acupuncture, physiotherapy, relaxation and exercise.
Before taking any medicine when pregnant or breastfeeding, a woman should ask for advice from her obstetrician, midwife or GP. If a pain relief drug is needed, the lowest effective dose should be taken for the shortest possible time. If possible, all drugs should be avoided during the first trimester (up to 12 weeks of pregnancy), but some will need to be continued to prevent harm to the woman.
With its excellent safety profile, paracetamol is widely used as the first line pain relief drug treatment throughout pregnancy and during breastfeeding.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Where possible, women should avoid taking NSAIDs (e.g. ibuprofen) before 30 weeks of pregnancy. If needed and based on the advice of a doctor, a woman is encouraged to take the lowest effective dose for the shortest possible time. After 30 weeks of pregnancy women should not take NSAIDs.
Ibuprofen and diclofenac have been used extensively for breastfeeding women and are the preferred choices after paracetamol for postnatal women.
Opioids (including codeine, dihydrocodeine, tramadol and morphine)
These can be taken during all stages of pregnancy, however, the lowest effective dose of opioids should be used for the shortest possible time, and based on the advice of a doctor or midwife.
After giving birth, if a woman experiences more severe pain and is in need of additional pain relief then opioids should be used, but codeine should be avoided when breastfeeding.
Low doses of dihydrocodeine in combination with paracetamol can be bought over the counter. The lowest effective dose should be used for the shortest duration, and regular use of any opioid beyond 3 days should be under close medical supervision. Other opioids such as tramadol, morphine and high doses of dihydrocodeine can only be prescribed by a doctor.
Should women be concerned about use of painkillers in pregnancy and breastfeeding?
Evidence supports the use of appropriate pain relief options at the lowest effective dose for the shortest possible time to minimise any potential risks to the mother and baby.
Correct management of pain during pregnancy and after birth is essential to minimise the risk of adverse outcomes to the mother and baby. Inadequate treatment of pain can lead to the development of anxiety and depression, which can impact on a woman’s physical and psychological wellbeing, as well as her ability to care for and/or breastfeed her baby.
If a woman has any concerns, she should speak to her obstetrician, midwife or GP.
For more information, please refer to NHS Choices on use of paracetamol and NHS Choices on use of ibuprofen during pregnancy and the Best Use of Medicines in Pregnancy (BUMPS).
Declaration of interests (guideline developers)
Dr DL Bisson FRCOG, Bristol: None declared.
Dr SD Newell MRCOG, Bristol: None declared.
Dr C Laxton FRCA, North Bristol NHS Trust: None declared.