Is Codeine Safe to Take During Pregnancy?

What does the evidence say about codeine during pregnancy?

1. Some studies looking at codeine use in pregnancy suggest a small increased chance of certain birth defects, including spina bifida, cleft lip or palate, and intestinal or heart defects, though findings vary across studies without a consistent pattern. 1
2. Codeine use in the third trimester was linked to a higher chance of postpartum hemorrhage and emergency C-section in at least one study, though how likely these outcomes are with codeine taken exactly as prescribed isn't established. 2
3. A small share of people are 'ultra-rapid metabolizers' who convert codeine into morphine unusually fast, and the FDA has issued a boxed warning after nursing infants of these mothers experienced life-threatening or fatal breathing problems, which is why the agency recommends against breastfeeding while taking codeine. 3
4. For newborns exposed to opioids like codeine late in pregnancy, rooming-in with a parent and breastfeeding, when not otherwise contraindicated, are first-line, non-medication approaches shown to ease withdrawal symptoms and shorten hospital stays before medication is added. 4
5. Using an opioid like codeine close to delivery can cause withdrawal symptoms in the newborn, known as neonatal opioid withdrawal syndrome, a separate concern from the small birth-defect signal seen with use earlier in pregnancy. 1

Is codeine safe in each trimester?

• First trimester. In the first trimester, some studies have linked codeine use to a small increase in certain birth defects like spina bifida, cleft lip or palate, or intestinal and heart defects, though results are inconsistent across studies and an increased risk is not confirmed.
• Second trimester. By the second trimester, codeine is sometimes prescribed short-term for significant pain when other options aren't appropriate. Ongoing or frequent use is generally reserved for situations your provider has weighed carefully against alternatives.
• Third trimester. Close to delivery, codeine use has been linked to a higher chance of postpartum hemorrhage and emergency C-section in at least one study, and using an opioid near birth can cause withdrawal symptoms in the newborn that your baby's care team will watch for.