Is Hydrocodone (Norco) Safe During Pregnancy?

What does the evidence say about hydrocodone during pregnancy?

1. Two studies have pointed to a possible small increase in heart defects, spina bifida, or gastroschisis with first-trimester hydrocodone use, but two other studies found no increased risk, and any true increase appears small. 1
2. Opioid use close to delivery can bring on neonatal opioid withdrawal syndrome: symptoms like irritability, poor feeding, and tremors that typically start about 2 days after birth and can last more than 2 weeks. 2
3. For a mother who needs hydrocodone once her milk has come in, LactMed's guidance is to keep it to 2 to 3 days at a maximum of 30 mg a day with close attention to the baby, since higher, prolonged dosing above 40 mg a day should be avoided. 3
4. More than 80% of women fill an opioid prescription after a cesarean birth and about 54% do after a vaginal birth, but roughly three-quarters of the pills dispensed go unused, which is why current guidance favors the lowest effective dose for the shortest course alongside acetaminophen or ibuprofen. 4
5. Watch for increased sleepiness, trouble breastfeeding, breathing changes, or limpness in a baby whose mother is taking hydrocodone, and call the pediatric provider right away if any of these appear. 3

Is hydrocodone safe in each trimester?

• First trimester. Two studies have hinted at a small possible increase in heart defects, spina bifida, or gastroschisis with first-trimester hydrocodone use, but two other studies found no increased risk, and any increase appears small against the roughly 3% background rate of birth defects.
• Second trimester. Ongoing opioid use in the second trimester has been linked to poorer fetal growth and low amniotic fluid in some studies, especially at higher doses or with prolonged use, so any continued need is worth revisiting with your provider.
• Third trimester. Opioid use close to delivery can bring on neonatal opioid withdrawal syndrome, with symptoms like irritability, poor feeding, and tremors typically starting about 2 days after birth and lasting more than 2 weeks. Never stop hydrocodone abruptly without medical guidance.

Hydrocodone guidance while breastfeeding, once milk supply is established