Is Oxycodone (Percocet) Safe During Pregnancy?

What does the evidence say about oxycodone during pregnancy?

1. Studies of opioids as a medication class suggest a possible increased chance of birth defects, though no specific pattern of defects has been tied to oxycodone itself, and every pregnancy starts with a baseline 3 to 5 percent chance of a birth defect. 1
2. Oxycodone use in the third trimester has been linked to a higher chance of neonatal abstinence syndrome, with withdrawal signs such as irritability, poor sleep, extreme drowsiness, poor feeding, tremors, and in some cases seizures, typically appearing within two days of birth and sometimes lasting more than two weeks. 2
3. In a study of 76 breastfeeding mothers taking a median oxycodone dose of 33 mg a day, infants were estimated to receive about 2.8 percent of an infant-scaled oxycodone dose over 24 hours through milk, while a separate retrospective study found signs of central nervous system depression in 20 percent of infants, 28 of 139, whose mothers took oxycodone, compared with 0.5 percent for acetaminophen. 3
4. LactMed's guidance for breastfeeding parents once milk supply is established suggests limiting oxycodone to 30 mg a day for 2 to 3 days in outpatient care, avoiding extended-release formulations, and watching the infant closely for drowsiness, feeding trouble, or changes in breathing. 3
5. In a prospective study of 210 mother-infant pairs after cesarean delivery using a standardized low-dose oxycodone protocol of 5 mg every 4 to 6 hours as needed, 77 percent of mothers used opioids after delivery with zero cases of maternal respiratory depression, while 13 percent of infants showed a composite of monitored side effects such as sedation or limpness, a rate that trended higher when mothers used more than 70 morphine milligram equivalents. 4

Is oxycodone safe in each trimester?

• First trimester. First-trimester use hasn't been tied to a specific pattern of birth defects, though research on opioids as a broader class suggests a possible small increase in risk. Every pregnancy starts with a 3 to 5 percent chance of a birth defect regardless of exposure.
• Second trimester. Frequent opioid use in the second trimester, especially at higher amounts or for longer than prescribed, has been associated in studies of opioids as a class with poor fetal growth, low amniotic fluid, and a higher chance of C-section.
• Third trimester. Third-trimester use raises the chance of neonatal abstinence syndrome, with withdrawal signs like irritability, poor feeding, and tremors typically starting within two days of birth and sometimes lasting more than two weeks. Tell your delivery team about this medication ahead of time so your baby can be monitored.