Opioid Analgesic Use During Pregnancy: Commentary by Alan Rapoport, MD

This article on maternal treatment with opioid analgesics points out some shocking data that all physicians should know about. The study seems to be carefully done and demonstrates that there is a significantly increased chance of having a newborn with birth defects if the mother takes opiates between conception and the end of the third month of pregnancy. This is very important information, as most doctors advise women who are or about to become pregnant that opiates are relatively safe in pregnancy.

When speaking of migraine treatment, my advice to women is to take no medication at all during pregnancy, if possible. That includes the time from 10 days after the start of menses until the woman is sure that she is not pregnant because she has had her next period. Some women cannot tolerate the pain from migraine, and doctors usually let them take opiates during pregnancy as it has been said to be safe. This will probably stop now.

I tell my patients that it is safe for them to take vitamin B2 up to 400 mg per day and magnesium glycinate or magnesium taurate and others up to 400 mg per day during pregnancy. I also advise them to start biofeedback training. For acute care of migraine, I do not give any medication in the first trimester, but after that I suggest small doses of dexamethasone or NSAIDs only in the second trimester. Some doctors permit triptans and they are used in Europe, but I do not prescribe them during pregnancy.

I do not like pregnant women to use opiates, and now I will strongly advise them against it. It is also known that opiates do not stop migraine pain effectively and do nothing to halt the migraine process. They can even worsen migraine and cause dependency.

If this trial is considered well done by the experts, then the data should be spread far and wide. Furthermore, there may have to be changes in some product inserts as required by the FDA.