It has not been proven that tramadol has a teratogenic effect, that is to say that it is responsible for congenital malformations. However, studies on tramadol are relatively few, and, as a precaution, it is best to avoid taking this medication during pregnancy. Tramadol being an opiate medication, its use during pregnancy particularly exposes the risk of respiratory depression or the risk of withdrawal syndrome in the unborn child.
What is tramadol?
Tramadol is a powerful analgesic that belongs to the family of opiate drugs, that is to say derived from opium. It is a level 2 analgesic according to the WHO scale, as specified by the National Federation of Departmental Associations of Coordinating Physicians of Occitanie. Tramadol is an opioid used in the treatment of moderate pain. This medication comes in oral or injectable form. Tramadol exists alone, or in combination with another molecule such as paracetamol or dexketoprofen. Tramadol acts on the central nervous system (brain and spinal cord), and it has an inhibitory action on the reuptake of norepinephrine, and a stimulatory action on the release of serotonin. This product should be administered with caution. Indeed, like all opioid medications, tramadol can cause significant side effects.
Can you take tramadol when you are pregnant?
During pregnancy, tramadol should not be prescribed as first-line treatment, but its use remains possible. The Reference Center for Teratogens (Crat) thus specifies that there is currently no proven risk of malformation. Data on animal models show that there is no malformative or teratogenic risk in animals. There is also no data on humans allowing us to conclude that there is a risk of malformation. It is therefore important to explain to pregnant women that there is no risk of malformation if they have taken tramadol during the first trimester of pregnancy.
However, due to the small number of studies carried out, it is important to apply the precautionary principle: you should therefore avoid taking this type of treatment during pregnancy as much as possible. The Omedit Center (Observatory of Medicines, Medical Devices and Therapeutic Innovations) specifies that, during the first trimester, paracetamol and codeine, or even ibuprofen, should be preferred. However, tramadol can be used in the 2nd and 3rd trimester of pregnancy (while ibuprofen is prohibited). Care should be taken when taking tramadol in the last days of pregnancy. Indeed, tramadol passes into the placenta, and the neonatal and maternal concentrations are then identical.
What are the risks of using tramadol when you are pregnant?
While tramadol can be used throughout pregnancy, it should be administered at the lowest doses and for the shortest duration possible (although prolonged use is still possible). As tramadol crosses the placental barrier, even short-term treatment at the end of pregnancy can expose the future baby to neonatal opiate withdrawal syndrome. This syndrome results in a child who is irritable, hypertonic and utters high-pitched cries. This medication may also cause respiratory depression. Medical teams must therefore be informed as soon as possible of any possible use of tramadol. This product is an opiate, and it can trigger many side effects that can impact pregnancy. Tramadol can thus cause nausea, and therefore worsen first trimester nausea. It can also aggravate constipation, often present in pregnant women. It can also put you at risk of respiratory depression. In pregnant women, the cardiorespiratory system is impacted, so it is important to pay attention to any respiratory problems during pregnancy.
Tramadol can also cause drowsiness, anxiety problems or even sleep problems. Finally, it can increase blood pressure or affect the cardiovascular system, which can be problematic in women affected by high blood pressure or having cardiovascular problems. Finally, like all opiate medications, tramadol can cause dependence in mother and child. In all cases, taking tramadol always requires a medical prescription and regular monitoring. You should never stop treatment without medical advice, and you must always follow the medical prescription to the letter. During pregnancy, self-medication should always be avoided.
Sources
- PainkillersNational Federation of Departmental Associations of Coordinating Physicians of Occitanie
- Tramadol-PregnancyReference Center on Teratogens, July 21, 2022
- Good Use Sheet: management of pain in pregnant womenObservatory of medicines, medical devices and therapeutic innovations — Central Region — Omédit, September 2013
- Sheet Specificities concerning pregnant or breastfeeding women — Proper use of opioid medications: analgesia, prevention and management of use disorder and overdosesHigh Authority for Health, March 10, 2022
- Tramadol EG 50 mg, tabletPublic drug database, Ministry of Solidarity and Health, March 8, 2023
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