Pijnstillers tijdens zwangerschap of borstvoeding: Relevantie voor foetus of pasgeborene?

When analgesics are prescribed during pregnancy or breast-feeding, potential effects and side-effects on the fetus or breast-fed infant have to be considered. Despite recently reported studies on the association of paracetamol with an increased risk to develop asthma during childhood, paracetamol remains the preferred drug during pregnancy. Non-steroidal anti-inflammatory drugs (NSAIDs) may induce prenatal closure of the ductus arteriosus and are thus contraindicated in the third trimester of pregnancy. During lactation, the deposition of most NSAIDs in the mother's milk is very limited; Ibuprofen remains the product preferred. Patients already on chronic administration of moderately potent opioids (e.g. codeine, tramadol) should not be weaned from these drugs more intensely during pregnancy. Neonates may present a neonatal abstinence syndrome; mother's milk can reduce these symptoms. Recently, an oversedation of infants has been reported during breast-feeding by mothers treated with moderately potent opioids for postpartum analgesia. Thus repeated clinical evaluation of the neonate in the first weeks of life with specific emphasis for signs of both abstinence or oversedation is strongly recommended when the mother has been exposed to these drugs during either pregnancy or breast-feeding.