New resource offers guidance on opioids for pregnant women

What considerations should you have when prescribing opioids for pregnant women? The National Maternal and Child Oral Health Resource Center created a new guide to help dentists answer this very question.

The guide, which was created with funds from the U.S. Maternal and Child Health Bureau, covers pharmacological considerations for pregnant women, neonatal opioid withdrawal syndrome, and general guidelines for prescribing opioids for these patients. It was written by Ruth Barzel, Sarah Kolo, and Katrina Holt, MPH, RD, and published by the National Maternal and Child Oral Health Resource Center on its website in late November 2018.

"Pain management is necessary for some dental procedures," the authors wrote. "In many cases, nonopioid over-the-counter medication combinations can be as effective as opioid combinations with fewer side effects. In some other cases, small amounts of opioids, followed by acetaminophen or ibuprofen, may need to be prescribed."

Dental care during pregnancy is safe and can help prevent the transmission of caries-causing bacteria to newborn children, according to multiple experts, including general dentists and public health educators. While pain management is necessary for some treatments, pregnant women have special considerations.

Some pain medications, including acetaminophen, codeine, meperidine, and morphine, may be used during pregnancy. But the guidelines caution that aspirin, ibuprofen, and naproxen should only be used for two to three days during pregnancy and should be avoided in the first and third trimesters. The guidelines also encourage dentists to use nonopioids as the first line of medications for pain management.

When possible, the guide recommends using local anesthesia, such as regional nerve blocks, to reduce postsurgical pain and the need for opioids. If an opioid is prescribed to treat acute dental pain, prescribe it for a short duration, choose the lowest potency needed, and do not prescribe long-acting or extended-release opioids, the authors advised.

As with other patients, the guide recommends checking with your state's prescription drug monitoring program before prescribing an opioid to pregnant women. These programs contain data about patients' prior and current opioid prescriptions to help facilitate safe prescribing.

It is also important to educate your patients about the safe use and disposal of opioids, side effects, overdose risks, and the potential for addition. It can also be beneficial to consult with the patient's primary care provider if the patient is already taking opioids, has a history of substance use disorder, or is at risk for aberrant drug-related behavior.

Finally, it can be helpful to know the symptoms of neonatal opioid withdrawal syndrome (NOWS). The syndrome, which may include tremors, crying, fever, and vomiting, can occur if a pregnant woman uses opioids for an extended period of time. The U.S. Food and Drug Administration has issued that a NOWS warning appear on all prescription opioids.