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 Pract. 2019 Nov;19(8):875-899. doi: 10.1111/papr.12814. Epub 2019 Aug 13.
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.
怀孕期间疼痛很常见，其管理也很复杂。某些镇痛药可能会增加胎儿和妊娠不良结局的风险，而疼痛管理不善则可能导致产妇出现不良结局，如抑郁和高血压。缺乏指导临床医生评估母亲和胎儿接触镇痛药的风险和益处的指南，因此需要为妊娠期间的疼痛管理提供循证建议。
进行了全面的文献检索，以评估药物和非药物疼痛管理方法的妊娠安全性数据。使用多个医学数据库确定了相关的临床试验和观察性研究，并对纳入的研究进行了质量评估和可能存在的偏倚评估。
扑热息痛和非甾体抗炎药（NSAIDs）适用于轻度至中度疼痛，但由于已确定的风险，NSAIDs 应避免在妊娠晚期使用。短期使用较弱的阿片类药物通常是安全的，尽管在第三孕期接触后必须监测新生儿戒断综合征。关于普瑞巴林和加巴喷丁的安全性数据有限，表明这些药物不太可能是主要的致畸剂，三环类抗抑郁药和 5-羟色胺去甲肾上腺素再摄取抑制剂的安全性数据有限，但总体上令人放心。纳入的许多研究都受到方法学问题的限制。
本综述的结果可以为临床医生为孕妇开具镇痛药提供指导。治疗应针对最低治疗剂量和最短可能持续时间进行调整，并且管理应包括讨论风险和益处以及监测反应。需要进一步研究以更好地了解各种镇痛药在妊娠中的安全性概况。
