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Oliver Myers
Oliver Myers

Pain Pregnant HOT!

Pregnancy hormones, your growing belly and weight gain during pregnancy can cause lower-back pain, especially in the later months. Pressure from the uterus can affect your sciatic nerve, which goes from the lower back to the hip and down the back of the leg. Pain along the sciatic nerve is called sciatica.

pain pregnant

As your baby grows, the muscles around the uterus (womb) pull and stretch. This can cause pain low in your belly. You may feel it most when you cough or sneeze. It usually goes away if you stay still for a bit or if you change to a different position.

Heartburn is a painful, burning feeling in the throat or chest. It happens when food or stomach acid backs up into the tube that carries food, liquid and saliva from your mouth to your stomach (esophagus). Heartburn is common during pregnancy because pregnancy hormones relax the valve between the stomach and the esophagus, and your growing uterus (womb) puts pressure on your stomach.

During pregnancy, your body will go through a lot of changes as your baby grows and your hormones change. Along with the other common symptoms during pregnancy, you will often notice new aches and pains.

Most often, this happens between 18 and 24 weeks. When you feel stretching or pain, move slowly or change positions. This is called round ligament pain and may be helped by wearing a maternity girdle.

Mild aches and pains lasting for short periods of time are normal. But see your provider right away if you have constant, severe abdominal pain, possible contractions, or you have pain and are bleeding or have fever. These are symptoms that can indicate more severe problems, such as:

Do you have questions about the effects of drugs, chemicals, radiation, or infections in women who are pregnant or breastfeeding? We invite you to submit them to the Motherisk Program by fax at 416 813-7562; they will be addressed in future Motherisk Updates.

Analysis of 2019 survey data found that 6.6% of women reported prescription opioid use during pregnancy. Among these women, 21.2% reported misuse (a source other than a health care provider or a reason for use other than pain), 27.1% wanted or needed to cut down or stop using, and 31.9% reported not receiving provider counseling about how use could affect an infant.

Obstetric providers should discuss risks and benefits of opioid therapy for chronic pain during pregnancy, screen all pregnant women for substance use, misuse, and use disorders, including those involving prescription opioids, and provide referral and treatment, as indicated.

Methods: CDC analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey in 32 jurisdictions and maternal and infant health surveys in two additional jurisdictions not participating in PRAMS to estimate self-reported prescription opioid pain reliever (prescription opioid) use during pregnancy overall and by maternal characteristics among women with a recent live birth. This study describes source of prescription opioids, reasons for use, want or need to cut down or stop use, and receipt of health care provider counseling on how use during pregnancy can affect an infant.

Results: An estimated 6.6% of respondents reported prescription opioid use during pregnancy. Among these women, 21.2% reported misuse (a source other than a health care provider or a reason for use other than pain), 27.1% indicated wanting or needing to cut down or stop using, and 68.1% received counseling from a provider on how prescription opioid use during pregnancy could affect an infant.

Conclusions and Implications for Public Health Practice: Among respondents reporting opioid use during pregnancy, most indicated receiving prescription opioids from a health care provider and using for pain reasons; however, answers from one in five women indicated misuse. Improved screening for opioid misuse and treatment of opioid use disorder in pregnant patients might prevent adverse outcomes. Implementation of public health strategies (e.g., improving state prescription drug monitoring program use and enhancing provider training) can support delivery of evidence-based care for pregnant women.

Among women who used prescription opioids, 88.8% reported using the opioids for pain reasons, 14.4% for reasons other than pain, and 4.9% for other/undetermined reasons. In particular, prescription opioids were used to relieve pain from an injury, condition, or surgery that occurred before (22.2%) or during (63.8%) pregnancy or during an unstated time frame (11.7%). Commonly reported reasons for use other than pain were to help sleep (7.9%) and relieve tension or stress (7.7%).

In this population-based sample of women with recent live births in 34 jurisdictions, one in 15 (6.6%) respondents self-reported using prescription opioid pain relievers during pregnancy. This observed prevalence of use during pregnancy in 2019 is lower than estimates of prescription opioid fills from administrative data (e.g., insurance claims) in previous years (5,6), which do not necessarily correlate with use. Higher use of prescription opioids among women who reported smoking cigarettes or had depression during pregnancy are consistent with findings from studies analyzing administrative Medicaid data (7).

Clinical guidance addresses opioid prescribing and tapering during pregnancy, the risks to the mother and infant, and screening and treatment for opioid dependence and opioid use disorder (3,10). CDC and the American College of Obstetricians and Gynecologists (ACOG) recommend that clinicians and patients discuss and carefully weigh risks and benefits when considering initiation of opioid therapy for chronic pain during pregnancy (3,10). Opioids, if indicated, should be prescribed only after consideration of alternative pain management therapies (3,10). Risk for physiologic dependence and possibility of an infant developing neonatal opioid withdrawal syndrome should be discussed (10). Clinicians caring for pregnant women are advised to perform verbal screening to identify and address substance use, misuse, and substance use disorders (10,11). Co-occurring use of other substances (e.g., tobacco) and mental health conditions are more common among pregnant women who are prescribed or misusing prescription opioids than among those who are not (7,12). Recommended screening and, if applicable, treatment and referral for depression, history of trauma, posttraumatic stress disorder, and anxiety should occur (10). Because of the possible risk for spontaneous abortion and premature labor associated with opioid withdrawal (10), clinicians are encouraged to consult with other health care providers as necessary if considering tapering opioids during pregnancy (3). Medications for opioid use disorder, including buprenorphine or methadone, are recommended because of their association with improved maternal outcomes (3,10,13). Collaboration between obstetric and neonatal providers is important to diagnose, evaluate, and treat neonatal opioid withdrawal syndrome because it can result from medically indicated opioid prescription use, medication for opioid use disorder, or illicit opioid use (3,10).

The findings in this report are subject to at least five limitations. First, these population-based data are only generalizable to women with a recent live birth in the 34 jurisdictions included in this report. Because of the need to provide data on the opioid crisis among pregnant women, a response rate threshold was not required for jurisdictions to be included in the analyses. This might further affect generalizability because 13 jurisdictions fell below the current PRAMS threshold of 55% (9). Second, prescription opioid use was self-reported and might be underestimated because of stigma and legal implications. Third, question misinterpretation by respondents is possible. For example,

Opioid prescribing consistent with clinical practice guidelines can ensure that patients, particularly those who are pregnant, have access to safer, more effective chronic pain treatment and reduce the number of persons at risk for opioid misuse, opioid use disorder, and overdose. Implementation of public health strategies can complement these efforts to improve the health of mothers and infants. The PRAMS surveillance system can be used to identify opportunities for providers, health systems, and jurisdictions to better support pregnant and postpartum women and their families.

Round ligament pain is a sharp pain or jabbing feeling often felt in the lower belly or groin area on one or both sides. It is one of the most common complaints during pregnancy and is considered a normal part of pregnancy. It is most often felt during the second trimester.

Belly pain during pregnancy can be due to many different causes. It is important for your doctor to rule out more serious conditions, including pregnancy complications such as placenta abruption or non-pregnancy illnesses such as:

Purpose: We describe exercise level in mid-pregnancy, associated sociodemographic variables, and investigate the association between exercise in mid-pregnancy and subsequent low-back pain, pelvic girdle pain and depression at 32 weeks of pregnancy.

Material and methods: The study included 3482 pregnant women participating in the Akershus Birth Cohort study (response rate 80.5%). Data were collected by a questionnaire in pregnancy weeks 17-21, pregnancy week 32 and electronic birth journal. The results were analysed by logistic regression and are presented as crude (cOR) and adjusted OR (aOR) with 95% CI.

Conclusions: Few Norwegian women follow current exercise prescriptions for exercise in mid-pregnancy. The results may indicate an association between exercising mid-pregnancy and lower prevalence of low-back pain, pelvic girdle pain and depression in late pregnancy. 041b061a72


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