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Pain Pract. 2019 Jun 26. doi: 10.1111/papr.12814. [Epub ahead of print]

Medication Use and Pain Management in Pregnancy: A Critical Review.

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Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW, Australia.
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.
Pain Management Centre, Prince of Wales Hospital, Randwick, NSW, Australia.
Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
MotherSafe, The Royal Hospital for Women, Randwick, NSW, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
Department of Pain Medicine, Singapore General Hospital, Singapore, Singapore.
University of New South Wales, Sydney, NSW, Australia.
Women's Health and Research Institute of Australia, Sydney, NSW, Australia.



Pain during pregnancy is common, and its management is complex. Certain analgesics may increase the risk for adverse fetal and pregnancy outcomes, while poorly managed pain can result in adverse maternal outcomes such as depression and hypertension. Guidelines to assist clinicians in assessing risks and benefits of exposure to analgesics for the mother and unborn infant are lacking, necessitating evidence-based recommendations for managing pain in pregnancy.


A comprehensive literature search was conducted to assess pregnancy safety data for pharmacological and nonpharmacological pain management methods. Relevant clinical trials and observational studies were identified using multiple medical databases, and included studies were evaluated for quality and possible biases.


Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are appropriate for mild to moderate pain, but NSAIDs should be avoided in the third trimester due to established risks. Short courses of weaker opioids are generally safe in pregnancy, although neonatal abstinence syndrome must be monitored following third trimester exposure. Limited safety data for pregabalin and gabapentin indicate that these are unlikely to be major teratogens, and tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors have limited but overall reassuring safety data. Many of the included studies were limited by methodological issues.


Findings from this review can guide clinicians in their decision to prescribe analgesics for pregnant women. Treatment should be tailored to the lowest therapeutic dose and shortest possible duration, and management should involve a discussion of risks and benefits and monitoring for response. Further research is required to better understand the safety profile of various analgesics in pregnancy.


analgesia; analgesics; headache; lower back pain; obstetric; obstetric pain; opioid; pain


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