Is it safe to take painkillers during pregnancy? Can you give your child paracetamol?
You're pregnant and you have the headache from hell - should you pop a pill? And what about dosing up little ones? Helen Foster asks the experts
The problem with taking any drugs when you’re pregnant is that we lack the absolute science as to how they might affect your baby. This is because, while drugs are thoroughly tested before they come on to the market, most trials exclude pregnant women. The reason is sensible: many drugs pass from mum to the foetus and drug companies don’t want to take the risk that something bad might happen during a trial. The downside of this is that we can’t find out for sure whether a drug is safe for a mum-to-be.However, with around one in six pregnancies in the UK being unplanned, many women take medications long before they know they’re expecting. And when our mums and grans were pregnant, there weren’t so many safety concerns so they often knowingly took medication. The result is that, even though drug companies might not have trialled drugs on pregnant women, the women themselves have. As Jane Bass, spokesperson for the Royal Pharmaceutical Society, says, ‘Most painkillers have been used for years, so we’re sure of any major potential effects of using them in pregnancy and breastfeeding.’
‘Major effects’ means things such as the risk of birth defects, miscarriage or premature delivery. But scientists are now looking beyond these areas and investigating the potential effects of painkillers taken in pregnancy or while breastfeeding on conditions that develop later in childhood, including asthma, hyperactivity and learning problems – and this is throwing up potential links. These links are very small, and the research is not conclusive but it does mean that right now, experts can’t say any painkiller is completely safe to use when you’re pregnant or breastfeeding. That doesn’t mean you shouldn’t use them, but that you should weigh up the risks and benefits.
The same analysis applies to painkillers for children. While it’s true that studies show slightly raised risks of complications for children who are given drugs early in life, the main reason we give tots painkillers is to bring down high fevers and, says pharmacist Roger Knaggs of the Royal Pharmaceutical Society, an untreated fever can lead to fits known as febrile convulsions. While these aren’t dangerous as such, they are distressing, so the general advice is to treat fevers rather than let kids suffer.
If and when you do choose to use painkillers, there are definite rules on what to opt for. Here’s what you need to know.
Aspirin is one of a class of drugs known as non-steroidal anti-inflammatories (NSAID). It is used to treat pain and fever and, in low doses, is given to thin the blood.
‘As a painkiller we don’t recommend using aspirin in pregnancy as there’s a small risk the drug can damage the stomach lining and cause gastric bleeding,‘ says Jane. Aspirin taken later in pregnancy can also be linked to a problem called premature closure of the ductus arteriosus (see the ibuprofen box for more on this). However, very low-dose aspirin – 75mg a day compared to the total of 4g you might take over the course of a day for pain – can be used in pregnancy to reduce the risk of pre-eclampsia and is not deemed to pose a risk. Only take aspirin with a doctor’s advice.
‘While we don’t know that there’s a definite risk when breastfeeding, it’s theoretically possible and so we don’t recommend taking it,’ says Jane. One of the problems associated with aspirin is a condition that affects children called Reyes Syndrome, causing damage to the liver and brain. This can develop after a viral infection such as flu or chickenpox, and a link has also been made with children using aspirin while they were ill. If you’re taking low-dose aspirin for medical reasons, you can still breastfeed, but ask your doctor’s advice on how long to leave between taking aspirin and feeding. You may also be advised to switch to formula if your child has a fever.
Because of the risk of Reyes Syndrome, aspirin is not recommended to any child under 16 without a doctor’s advice.
This is another drug that reduces both pain and fever, and is the main ingredient in Calpol.
‘Unless you’re allergic to it, paracetamol is the recommended painkiller to be used during pregnancy,’ says Jane. ‘There are no studies showing risks of any birth defects associated with it.’ One recent study made headlines by linking the use of paracetamol in pregnancy with a slightly higher risk of asthma – it found children were 13 per cent more likely to have asthma by the age of three if their mother had taken paracetamol when pregnant. That’s a small rise though, and the link is by no means proven; the researchers say advice shouldn’t change in light of this.
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‘It is thought to be generally safe for children,’ says Roger. While the recent trial did note a higher risk of asthma in children who had taken paracetamol, it’s not yet proven.
Another member of the NSAID family of drugs, ibuprofen helps reduce pain and fever.
Ibuprofen isn’t generally recommended during pregnancy and it must never be used after the 30th week. It’s linked to a problem known as premature closure of the ductus arteriosus. ‘This is the name of a blood vessel in the baby that supplies them with nutrients and oxygen from you. It closes when the baby is born, but must stay open when they are in the womb – however, ibuprofen can cause it to close early,’ explains Jane. NSAIDs taken in late pregnancy have also been linked to reduced levels of amniotic fluid, which can cause complications.
The known risks to the foetus from ibuprofen disappear once they are born ‘and there’s no risk to using ibuprofen when you’re breastfeeding,’ says Jane.
‘Generally, ibuprofen is safe to use on children – the exception to this is those with asthma,’ says Roger. ‘Five to ten per cent of people with asthma find it can aggravate their symptoms and so it’s generally recommended that they don’t use it.’ It’s also not a good idea to give ibuprofen to children who have chickenpox as it can cause a reaction that makes the spots go deeper into the skin, which may then lead to infection.
WHAT ABOUT THE DENTIST?
It’s important to keep up good dental hygiene when you’re pregnant, as gum disease has been linked to an increased risk of premature birth, and infected teeth that aren’t tackled can lead to mouth infections that may then require you to have more intensive treatment. But what if your dentist wants to use an anaesthetic? Don’t worry, says the British Dental Association. ‘The local anaesthetic used in dentistry is not considered to be a risk for either mother or foetus. Only a small amount is required and the effect is localised. The injection includes adrenaline which causes blood vessels in the area to close down and this prevents the drug from spreading beyond the tooth or gum.’
Codeine is a stronger painkiller that is normally given for mild to moderate pain. It’s also found in some cough mixtures as it can help suppress coughing.
‘There’s no known risk of birth defects associated with taking codeine in pregnancy, but it is converted to morphine in the body and therefore if it’s taken regularly in the days before giving birth, some babies can potentially suffer withdrawal once they are born,’ says Jane. If your doctor knows you’ve been taking codeine in the days or weeks before birth, they might want to monitor your baby a bit more carefully afterwards. If you have a long-term pain condition that’s regulated with codeine, ask your doctor’s advice about continuing it when pregnant; if you’ve been taking it for a long time, you might also need advice on what to do if you decide to manage without it.
Codeine can be given by hospitals as a painkiller after birth, but generally it’s not recommended that you take it when breastfeeding. A very small proportion of the population convert too much from a normal dose to morphine. If you’re one of them, more morphine than normal will enter your breastmilk which can affect your baby – at worst, this can cause problems with breathing. If you need codeine to control a long-term condition but still want to breastfeed, ask your doctor’s advice.
‘In the past, codeine used to be commonly used after operations such as tonsillectomy but it’s now contraindicated in children under 12, and also isn’t used in anyone under 18 with a breathing problem called obstructive sleep apnoea,’ says Roger. The reasons for this include the risk of rapid metabolism – in some children the liver may be prompted to convert too much of the codeine dose to morphine – and its potential effect on breathing. In these cases, children can experience severely slowed breathing rates as a consequence.
HOW YOU CAN HELP
One of the reasons we’re so cautious about the use of any drug in pregnancy is that we simply don’t know what the risks might be – and it’s hard to conduct studies to find out. That’s why the organisation UKTIS is asking pregnant women to register for a My Bumps Record on medicinesinpregnancy.org. ‘It’s an anonymous survey that you sign up for when you find out that you’re pregnant,’ says Dr Laura Yates from UKTIS. ‘We ask you to let us know of any medication you take during your pregnancy and then to answer a few questions once your baby is born and, ideally, yearly during their childhood. This data can then help us spot any patterns associated with the drug.’ If you’re curious about any other possible drug interactions, the website also has fact sheets on many common medicines and their safety during pregnancy.