Tramadol During Pregnancy

Despite the fact that tramadol is one of the potent analgesics with a lower risk of psychological or physical dependence, there is concern surrounding its consumption by pregnant mothers. Since fetuses have under-developed systems, tramadol is a topic of huge debate regarding its safety during pregnancy.

Why do most women require pain medication during pregnancy?

Pregnancy is a physiological state of hormonal irregularities that produce a variety of symptoms. Most pregnant mothers battle a variety of pain symptoms during pregnancy that may be trivial (not requiring any pain medication) or severe (requiring pain medication and other forms of pain management).

These include:

• Headaches and migraine due to changes in the hormonal concentration. Pregnancy hormones produce changes in the caliber of blood vessels.
• Backache due to the pressure on the spine of the expanding uterus
• Lower pelvic pain caused by changes in the strength and stability of ligaments as a result of the pregnancy hormone (in an attempt to prepare the pelvis for delivery)
• Pain involving lower limbs as a result of maternal weight gain that press upon nerves, muscles, and ligaments leading to edema and pain.

Is Tramadol safe during pregnancy?

Analgesics or painkillers are usually avoided during pregnancy. This is because most painkillers can affect blood supply to the baby by interfering with the caliber of umbilical vessels. This concern is huge with non-steroidal anti-inflammatory drugs (NSAIDs). Non-steroidal anti-inflammatory drugs constrict or narrow down all major blood vessels. It can impair nutrition delivery to the baby, leading to growth restriction or even fetal death. Moreover, since most cases of pain are caused by damage to the integrity of nerves, ligaments or bones, most NSAIDs are ineffective and not usually advised during pregnancy. Opioids are another class of painkillers, different and distinct from NSAIDs, that include tramadol, morphine, and codeine.

According to the FDA classification of drugs, tramadol is not a safe drug to be consumed during pregnancy because it is considered a Class 3 drug:

• Not enough data on human models are available to assess the degree of side effects. Data from experiments conducted on animal models suggest tramadol can cause moderate to severe side effects in the embryo or developing babies.
• Tramadol administration at the time of delivery is strictly contra-indicated due to the risk of moderate respiratory depression and collapse in fetus.

What are the complications of Tramadol consumption during pregnancy?

The babies are at risk of developing severe withdrawal symptoms if tramadol is consumed by mothers for long intervals during pregnancy. The withdrawal symptoms may be observed within 24 - 48 hours post-birth and include a high-pitched inconsolable cry, trembling and changes in respiration.

De Wit presented a case of a 25-year-old female who consumed 100 mg tramadol tablets (3 times a day, a total of 300 mg/day) during pregnancy for the management of chronic headache and migraine attacks. Due to the risk of withdrawal symptoms, delivery was done in a tertiary care setting where the baby was born normally but developed severe withdrawal symptoms 36 hours post- birth. After 3 days of close observation, intensive care, and treatment with phenobarbital, the baby was discharged home.

Research data on animals suggest an increased risk of miscarriage or fetal anomalies to the embryo exposed to higher doses. Other notable complications observed in embryos of mice and rat include bone deformities, low birth weight and growth restriction.

Recommendations for Tramadol use during pregnancy

• For best results and uneventful pregnancy, it is recommended that expecting mothers avoid tramadol.
• If the pain is unresponsive to other pain remedies, a smaller dosage may be administered at infrequent intervals. Tramadol can cross the placental barrier and may concentrate within the fetal circulation.
• In any case, the dosage must not exceed 50 to 100 mg/ day.
• Be sure to consult your healthcare professionalbecause sometimes the co-existence of another medical problem can increase the risk of complications with tramadol use.
• If you are addicted/habituated to tramadol or have been on tramadol, avoid getting pregnant and consult your healthcare provider to wean you off the medication.