Tramadol in Pregnancy – Safety, Risks, and Precautions

Tramadol while pregnant should only be used when your doctor believes it is necessary, as it may not be the safest pain relief option for every pregnancy. While some women may be prescribed tramadol for severe pain, its effects can differ depending on when it is taken and the reason for treatment. Understanding the use of tramadol in pregnancy first, second and third trimester is important because each stage of fetal development comes with different considerations. In this guide, you’ll learn when tramadol may be prescribed, its possible effects on the mother and baby, the concerns linked to each trimester, and the precautions to discuss with your doctor before taking it.

What Is Tramadol (Ultram)?

Moderate to severe pain during pregnancy can be treated by tramadol, a medication that works by affecting the balance of mood chemicals in the brain (1). This is often prescribed to patients who are suffering from an injury or when recovering from surgery. Sometimes, it is used as a recreational drug, but in doses much higher than that required when it is only used as a painkiller.

Why Do Pregnant Women Require Pain Medication?

During pregnancy, the body undergoes physiological and hormonal irregularities that result in different symptoms. Sometimes, the symptoms are trivial and do not require any kind of pain medication, but there are also times when the pain is quite severe and requires some kind of action. Here are some reasons why pregnant women may need to take something for the pain:

• The diameter of blood vessels changes due to the hormonal changes during pregnancy and results in headaches and migraines. The intensity of these can vary, but they have been known to be severe enough to warrant some kind of medication for relief.
• Pressure on the spine caused by your expanding foetus can result in backaches that can sometimes become unbearable. Those who are carrying multiples will find this especially relevant in their case.
• The stability and strength of the ligaments change as the body tries to prepare the pelvis for delivery. This results in a lot of pelvic pain that may sometimes require medication.
• Your lower limbs have had to deal with a lot of extra weight, and this causes pain from all the nerves and ligaments that have been bearing the strain of your baby’s additional weight.

Is Tramadol Safe in Pregnancy?

Though there are some medications out there with more serious side effects of dependency due to their higher opioid content, tramadol is also known to cause addiction and neonatal dependency on the drug (2). The painkillers may also cause changes in the diameter of the umbilical vessels, which can have an effect on the flow of blood to your baby. This is why it is best to stay away from painkillers in general during your pregnancy unless you have no choice but to take them. If the blood flow is restricted, your baby will not get enough nutrition, which could result in restrictions in growth and, in extreme and unfortunate cases, the death of the child.

So, can you take tramadol while pregnant? Only if prescribed by your doctor when there is no other choice. That is the use of tramadol during pregnancy should be reserved for situations when other pain managements are unable to relieve pain (3). It is best to stay away from it as it is not considered safe due to a lack of proper study. Some tests showed that tramadol has the possibility of causing moderate to severe damage to the foetus in the form of cardiovascular defects (4). Respiratory depression and collapse in the foetus is a very serious threat, and so the use of tramadol is strictly forbidden during delivery.

What If a Pregnant Woman Has Already Taken Ultram in Pregnancy?

If you have taken tramadol, let your doctor know so you can get the proper advice on going about it from there. The smallest possible dose will be prescribed if your doctor feels you need it. But most doctors will prescribe something less harmful. If you take them frequently and want to stop, it is not advised to stop taking them cold turkey. Instead, bring this to your doctor’s attention so that you can get professional help in weaning yourself off the drug without incurring the sudden withdrawal symptoms that can take place from such a sudden action. If the drug is stopped cold turkey, you are likely to experience irritation, anxiety or panic, diarrhoea, chills, hallucinations, and so much more. 

Complications & Side Effects of Taking Tramadol During Pregnancy

Here are some of the complications or side effects associated with taking tramadol during pregnancy:

1. Easily Abused

The central nervous system responds to pain differently because tramadol changes this aspect, making it very easy to abuse the drug.

2. Maternal and Foetal Addiction

Due to the potent opioid components in this drug, it is addictive in nature, something that is very dangerous for babies. If this drug is used consistently, there is a high chance that babies will become dependent on it (5). Even after the drug is discontinued, babies will still experience withdrawal symptoms one month after birth. Babies can also experience birth defects or premature births. A few other symptoms include irritability, jitteriness, seizures and abnormal muscular activity (6) (7).

3. Dangerous Combos

If this drug is mixed with other medication, it may cause uncontrollable shaking, and seizures can result.

4. Simply Problematic

Even when taken in the correct dose, tramadol has been known to cause side effects, such as breathing issues, abdominal pain, itchiness and rashes, joint pains, depression, severe headaches, nausea, and more (8).

5. Learning and Behavioural Problems

Your baby’s brain is developing even until the end of your pregnancy. Taking medications during your pregnancy can have lasting effects on your child’s learning and behaviour.

6. Tramadol and Breastfeeding

Like some other medications, tramadol can be transferred into the breast milk. If babies consume too much of it through breast milk, they are likely to show signs of increased sleepiness, sedation, difficulty breastfeeding, difficulty breathing and limpness, and will need to see an expert.

Precautions to Follow While Taking Tramadol

If you do need to take this drug for some reason, keep the following precautions in mind:

• It is not meant to be used along with MAO inhibitors.
• Avoid alcohol during treatment.
• When it comes to patients who suffer from drug dependence, central genesis, liver dysfunctions, and increased sensitivity to opioid components, treatments with this drug should be avoided.
• Avoid it for treatment of narcotic withdrawal syndrome.
• It should not be used for more than the specific amount of time needed, as prolonged use can cause dependency on the drug.

Tramadol vs. Paracetamol: Which Is Safer During Pregnancy?

When it comes to pain relief during pregnancy, paracetamol is generally considered the safer first-choice option when used at the lowest effective dose for the shortest possible time. It has been widely used during pregnancy and is commonly recommended for treating mild to moderate pain and fever.

Tramadol, on the other hand, is an opioid pain reliever that is usually reserved for moderate to severe pain when other treatments are not effective. Because it can cross the placenta, tramadol may increase the risk of problems such as neonatal withdrawal symptoms if used for a prolonged period or close to delivery (9). It should only be taken during pregnancy if a doctor determines that the expected benefits outweigh the potential risks.

Alternatives of Tramadol While Pregnant

It is possible to relieve the pain during pregnancy without popping in a tramadol. You may try the following non-pharmacological methods to relieve pain during your pregnancy (10):

1. In case of a back ache, you can use a heating pad to provide relied from the soreness.
2. Engage in light exercises to stimulate blood flow and loosen the tightened muscles and tissues. Heavy and impactful exercises should be strictly avoided.
3. Prenatal yoga classes are a great help in keeping the body first during pregnancy and also provide relief from sore muscles.
4. You can also take a warm bath. Avoid hot or scalding water.
5. A massage therapy performed only by a certified and experienced masseuse can be undertaken.
6. Make sure to eat a healthy and balanced diet and keep yourself hydrated to avoid cramps.

When to Consult a Doctor?

If you are taking tramadol for pregnancy, stay in touch with your healthcare provider and seek medical advice if you:

• Have pain that persists or worsens despite taking tramadol.
• Need to take tramadol for more than a few days or require a higher dose to control your pain.
• Miss a dose, accidentally take more than the prescribed amount, or think you may have overdosed.
• Experience side effects such as severe drowsiness, dizziness, difficulty breathing, confusion, or fainting.
• Notice reduced fetal movements, vaginal bleeding, severe abdominal pain, regular contractions, or leaking of fluid.
• Develop signs of an allergic reaction, including swelling of the face, lips, tongue, or throat, or have difficulty breathing.

FAQs

1. Will the baby require extra monitoring during pregnancy or after delivery?

At around twenty weeks, most women are offered scans as a part of their antenatal care. Here, they will check for birth defects in the baby. Though using tramadol is not actually expected to cause any problems that would require the need for extra monitoring, those who need to take the drug for a particular medical condition are watched more closely so that you can be sure that your baby is growing and developing the correct way. Women who tend to use the drug for recreational purposes are watched even more closely. Those women who have had to take tramadol during their late pregnancy will have babies who will need to be kept for observation after birth for any kind of signs of withdrawal.

2. Does it affect the baby’s health if the father has taken tramadol?

So far, we have seen how tramadol and pregnancy go together from the maternal side. Though there has been no study dedicated to investigating the effects of tramadol on the father on the unborn child, most experts say that it is not likely that the drug can cause any harm to the baby through the sperm. According to a 2017 study published in the Biochem Pharmacol (Los Angel), an open-access journal, long-term use of tramadol in males may cause male infertility (11). However, more study in this area is needed, especially on the effects the drug has if the father takes it at the time of conception.

3. How long does tramadol stay in the pregnant woman’s system?

On average, tramadol stays for about two to three days in the pregnant woman’s system before it is cleared out (1).

4. How can I flush tramadol out of my pregnant system?

Although there’s no specific method documented yet to get the drug out of the system, you may stay hydrated, exercise lightly, and have a balanced meal to fight against the pain and get tramadol out of the system.

Always keep a record of any medications you take so that you can inform your doctor about them if and when needed. If you have any need to see a doctor for your own health, make sure that the doctor knows that you are pregnant so that this can be taken into consideration when medication is being prescribed for you.

Being prescribed medication like tramadol, something that has been known to cause some unpleasant side effects, you will have to examine the benefits and disadvantages before deciding on whether it is worth taking the risk. How medications affect your baby is important, and you need to be very careful about what medication you decide to put into your body.

Also Read: 

Doxinate Oral in Pregnancy
Taking Loratadine while Pregnant
Should You Take Omeprazole in Pregnancy?
Taking Labetalol in Pregnancy – Is It Safe?
List of Unsafe Medicines Pregnant Women Should Avoid

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Sources References

1. National Library of Medicine – Tramadol

2. U.S. Food and Drug Administration – ULTRAM ER (tramadol hydrochloride)

3. Uktis – Use of Tramadol in Pregnancy

4. PubMed – Use of tramadol in early pregnancy and congenital malformation risk

5. GPnotebook – Tramadol in pregnancy

6. Journal of Perinatal Medicine – Neonatal abstinence syndrome (NAS) after intrauterine exposure to tramadol

7. Drugs.com – Tramadol Pregnancy and Breastfeeding Warnings

8. NIH – TRAMADOL HYDROCHLORIDE- tramadol hydrochloride tablet, film coated Teva Pharmaceuticals USA, Inc

9. NHS – Pregnancy, breastfeeding and fertility while taking tramadol

10. American College of Obstetricians and Gynecologists – Opioid Use and Opioid Use Disorder in Pregnancy

11. Biochemistry & Pharmacology – NOS Expression in Oxidative Stress, Neurodegeneration and Male Infertility Induced by the Abuse of Tramadol