Postpartum maternal prescription of codeine not a major risk to newborns: study

Babies born to new moms who have been prescribed codeine shortly after delivery were not at increased risk of various adverse neonatal outcomes such as death, hospitalization or need for resuscitation according to researchers at the Institute for Clinical Evaluative Sciences (ICES).

“Speculation exists that the use of codeine by nursing mothers might pose a threat to their newborn children. This is because morphine, which is formed from codeine, can pass into breast milk, and some women convert larger amounts of codeine into morphine than others. Over a 10-year period, we found no evidence that the prescription of codeine to women following delivery was associated with various measures of neonatal harm, including death or hospitalization,” says the study’s lead author and ICES scientist Dr. David Juurlink, who is also the Head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre. Juurlink went on to caution, “This study should not be construed as an endorsement of codeine therapy by breastfeeding women, or anyone else for that matter. And it’s important to appreciate that codeine can be dangerous when given directly to young children.”

The study examined whether postpartum maternal prescription of codeine was associated with an increased risk of harm to the newborn. Among the study’s findings:

• 7,804 infants whose mothers received a prescription for codeine shortly after delivery were matched to an equal number of infants whose mothers did not.
• Among neonates born to mothers who received a prescription for codeine, no increased risk of several adverse neonatal outcomes such as death, hospitalization for any reason, hospitalization for injury or dehydration or need for resuscitation were found.
• These findings suggest that serious neonatal harm is unlikely when codeine is prescribed to women following delivery. However, this is not an endorsement of the use of codeine by women during pregnancy and labour and more effective pain relieving treatments are available.

Some limitations of the study include a lack of information on breastfeeding patterns or the genetic makeup of study subjects, as well as the possibility that some women were given codeine without a prescription.

The study “Postpartum Maternal Codeine Therapy and the Risk of Adverse Neonatal Outcomes: A Retrospective Cohort Study” is in the current issue of Journal of Clinical Toxicology.

Authors: David N. Juurlink, Tara Gomes, Astrid Guttmann, Chelsea Hellings, Marco L.A. Sivilotti, Marie-Andrée Harvey, Muhammad M. Mamdani.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION CONTACT:

• Deborah Creatura
• Communications, ICES
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