(Date of issue: February 2014. Version: 2)
This factsheet has been written for members of the public by the UK Teratology Information Service (UKTIS). UKTIS is a not-for-profit organisation funded by Public Health England on behalf of UK Health Departments. UKTIS has been providing scientific information to health care providers since 1983 on the effects that medicines, recreational drugs and chemicals may have on the developing baby during pregnancy.
What is it?
Codeine is usually prescribed for mild or moderate pain, and sometimes to suppress a persistent cough.
Is it safe to take codeine in pregnancy?
There is no yes or no answer to this question. When deciding whether or not to take codeine during pregnancy it is important to weigh up the benefits of its use against the known or possible risks, some of which will depend on how many weeks pregnant you are.
This leaflet summarises the scientific studies relating to the effects of codeine on a baby in the womb. It is advisable to consider this information before taking codeine if you are pregnant. For some women, treatment with codeine in pregnancy may be necessary.
Your doctor is the best person to help you decide what is right for you and your baby.
What if I have already taken codeine during pregnancy?
If you have taken any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need the medicines that you are on and to make sure that you are taking the lowest dose that works.
Can taking codeine in pregnancy cause my baby to be born with birth defects?
A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.
There is no scientific proof that taking codeine during the first 12 weeks of pregnancy causes birth defects. Most studies show that women who take codeine in pregnancy are no more likely to have a baby with a birth defect than women who don’t. When specific types of birth defects were analysed some studies suggested a possible link between codeine use in pregnancy and certain heart defects, however other studies showed no link.
Can taking codeine in pregnancy cause miscarriage or stillbirth?
No link between codeine use in pregnancy and having a miscarriage or stillbirth is known about, however no scientific studies have been carried out that have specifically investigated this.
Can taking codeine in pregnancy cause preterm birth, or my baby to be small at birth (low birth weight)?
No link between codeine use in pregnancy and the baby being born early (before 37 weeks of pregnancy) or weighing less than 2500g was found in the one study which has investigated this. However, further research is needed to confirm these findings.
Can taking codeine in pregnancy cause learning or behavioural problems in the child?
A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy could have a lasting effect on a child’s learning or behaviour. No studies have been carried out to look at whether there is an increased risk of learning and behavioural problems in children who were exposed to codeine while in the womb.
Can taking codeine in pregnancy cause other health problems in the child?
Breathing problems at birth
Codeine affects breathing in some people. It is possible that codeine taken by a mother near delivery may be still in a baby’s bloodstream at birth and could cause the baby to have temporary breathing problems. Only one small study has investigated this. Although this study did not show that babies exposed to codeine during pregnancy are at increased risk of having breathing problems around the time of birth, information on more pregnant women is needed to be sure.
If you have taken codeine around the time of delivery your doctor may advise that your baby’s breathing is monitored after birth. If you are likely to be taking codeine towards the end of pregnancy it is advisable to plan, with your health care provider, where you are going to have your baby so that, if necessary, arrangements for your baby to be monitored are already in place.
Withdrawal symptoms at birth (‘neonatal withdrawal’)
Codeine is altered in the body to morphine. Studies have shown that some babies who have been exposed to morphine in the womb experience withdrawal symptoms after birth (as a result of no longer getting morphine through the placenta). Taking codeine near to the end of pregnancy may also cause neonatal withdrawal. If you have taken codeine around the time of delivery your baby may be monitored for a few days after birth.
There is no proof that taking codeine during pregnancy will cause your child to develop cancer.
One study has shown that mothers of children who developed a type of cancer called neuroblastoma were more likely to have taken codeine during their pregnancies. However, links have also been shown between neuroblastoma and many other factors. It is likely that some of these findings have resulted from how the information was collected or analysed, and the fact that the mothers took codeine in pregnancy may be a coincidental finding.
Will my baby need extra monitoring during pregnancy?
There is no evidence that taking codeine during pregnancy causes any problems that would require extra monitoring for your baby during pregnancy.
Are there any risks to my baby if the father has taken codeine?
We would not expect any increased risk to your baby if the father took codeine before or around the time you became pregnant.
Who can I talk to if I have questions?
If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org.
Up to 1 out of every 5 pregnancies ends in a miscarriage, and 1 in 40 babies are born with a birth defect. These are referred to as the background population risks. They describe the chance of these events happening for any pregnancy before taking factors such as the mother’s health during pregnancy, her lifestyle, medicines she takes and the genetic make up of her and the baby’s father into account.
Medicines use in pregnancy
Most medicines used by the mother will cross the placenta and reach the baby. Sometimes this may have beneficial effects for the baby. There are, however, some medicines that can harm a baby’s normal development. How a medicine affects a baby may depend on the stage of pregnancy when the medicine is taken. If you are on regular medication you should discuss these effects with your doctor/health care team before becoming pregnant.
If a new medicine is suggested for you during pregnancy, please ensure the doctor or health care professional treating you is aware of your pregnancy.
When deciding whether or not to use a medicine in pregnancy you need to weigh up how the medicine might improve your and/or your unborn baby’s health against any possible problems that the drug may cause. Our bumps leaflets are written to provide you with a summary of what is known about use of a specific medicine in pregnancy so that you can decide together with your health care provider what is best for you and your baby.
Every pregnancy is unique. The decision to start, stop, continue or change a prescribed medicine before or during pregnancy should be made in consultation with your health care provider. It is very helpful if you can record all your medication taken in pregnancy in your hand held maternity records.