Tag Archives: pregnancy

What Happens to the Baby of a Nursing Mother who Abuses Codeine or Tramadol

I know a young woman who was so addicted to codeine. Even when she was pregnant she was always high on codeine. She carried her pregnancy without experiencing any complication and her baby was delivered with ease, and then her abuse of codeine increased. I don’t know how much of the drug got to the baby while in the womb but after birth it was obvious that the baby was getting this drug through breast milk. The baby hardly cried and was always asleep. This nursing mother couldn’t stop or slow down her intake of codeine so the baby had to be taken away from her.

A lot of young people abuse codeine and tramadol to get a euphoric high, low, slow or strong feeling. This has become a societal problem because the abuse of these drugs like other opiates has many adverse effects more especially on babies and young children.

Codeine is a moderately strong opiate drug that is used in pain relief and for the suppression of coughs. Tramadol is an opioid pain medication used to treat moderate to moderately severe pain But strong or weak, these drugs are addictive with many symptoms of use in common with other opiates.

According to the New York Times, the United State Food and Drug Administration announced that any child younger than 12 should not take the opioid codeine and that those 18 and younger should not take tramadol, another painkiller, after certain types of surgery. In addition, nursing mothers should avoid both opioids because they pose dangers to breast-feeding babies.

The agency said, drug manufacturers will be required to update their package inserts to show the new contradictions, the strongest kind of warning, to alert doctors and parents that children can have trouble breathing or die after taking these drugs. Some over-the-counter cough or cold remedies contain codeine, so parents should read all labels to avoid accidentally giving it to their child.

Teenagers with certain conditions like severe lung disease, obesity or obstructive sleep apnoea that can impair breathing may be at particular risk, the agency cautioned.

According to New York Times, these warnings were prompted by a recent review of rare but alarming reports of life-threatening side effects from the drugs. Between January 1969 and May 2015, the F.D.A. identified 24 deaths and 40 cases of serious breathing difficulties in children younger than 18 worldwide tied to drugs that contain codeine. Of the 24 deaths, 21 occurred in children under 12.

The use of tramadol was linked to three deaths and six cases of respiratory troubles in children under 18 between January 1969 and March 2016. All of the deaths occurred outside the United States and involved tramadol given in oral drops, a formulation not available in this country. One case in the United States involved a 6-year-old who became unresponsive after a third dose of tramadol and fully recovered after two doses of naloxone, an antidote for opioid overdose.

The problem with both codeine and tramadol is that some people are “ultrarapid metabolizers” whose livers metabolize the drugs much too quickly, causing dangerously high levels of opioids to build up, said Dr. Douglas Throckmorton, the deputy director for regulatory programs at the F.D.A.’s Center for Drug Evaluation and Research. No test can identify who might metabolize the drug too quickly, and that is why the agency issued blanket warnings for children by age.

Certain ethnic groups may be especially sensitive to the drugs. Up to 10 percent of whites, for instance, are fast metabolizers, compared with up to 4 percent of African-Americans and up to 2 percent of East Asians. And more than 10 percent of people of Puerto Rican and Middle Eastern descent may be fast metabolizers.

Any breast-feeding mother could also be an ultrarapid metabolizer and not know it, and unwittingly pass on high levels of opioids to her nursing baby through breast milk. Excessive sleepiness, limpness, breathing troubles or even death can result.

“Because we can’t easily figure which children or nursing mothers specifically are at greater risk of ultra-rapid metabolism of codeine and tramadol, today we are requiring manufacturers of prescription codeine and tramadol products to make important labeling changes to protect those children who are at greater risk,” Dr. Throckmorton said.

Why Pregnant Women Must Have Protected Sex and Avoid Mosquito Bite

The Zika virus is causally linked to microcephaly, the birth defect that leads to abnormally small head size in infants, the U.S. Centers for Disease Control and Prevention declared Wednesday in The New England Journal of Medicine. The agency said it has not found any definitive new evidence but has weighed the accumulating data connecting the two conditions and concluded that it was solid enough to call causative.

Zika Fever

Zika infection known as Zika fever, often causes no or only mild symptoms, similar to a mild form of dengue fever. Common symptoms of infection with the virus include mild headaches, Maculopapular rash, fever, malaise, conjunctivitis, and joint pains.
The illness cannot be prevented by medications or vaccines. It is treated by rest.

Zika Virus

Zika virus got its name from the Zika forest of Uganda, where the virus was first isolated in 1947. Zika virus is related to Dengue, Yellow fever, and West Nile viruses.

Since the 1950s, Zika virus has been known to occur within a narrow equatorial belt from Africa to Asia. From the year 2013 – 2014, the virus spread eastward across the Pacific Ocean to French Polynesia, New Caledonia, the Cook Islands, and Easter Island, and in 2015 to Mexico, Central America, the Caribbean, and South America, where the Zika outbreak has reached pandemic levels.

Transmission by Mosquito

Zika is spread by daytime-active mosquitoes. It is primarily spread by the female Aedes aegypti mosquitoes .

Transmission Through Sex

Zika can be transmitted from a man to his sex partners. As of April 2016 sexual transmission of Zika has been documented in six countries – Argentina, Chile, France, Italy, New Zealand and the United States – during the 2015 outbreak.

All cases involve transmitting the Zika from men to women and it is unknown whether women can transmit Zika to their sexual partners.

Transmission During Pregnancy


In 2015, Zika RNA was detected in the amniotic fluid of two pregnant women whose fetuses had microcephaly, indicating that the virus had crossed the placenta and could have caused a mother-to-child infection.

Blood Transfusion

As of early April 2016 two cases of Zika transmission through blood transfusion have been reported globally, both from Brazil.

Risk Assessment for Africa

The WHO said though no systematic surveillance has been in place for tracking Zika virus in Africa, sporadic cases have been reported on the continent for many years. The agency added that the virus may be endemic in many parts of the continent where Aedes aegypti, the main vector of the disease, is prevalent.

Though it’s possible that some portion of the African population may have some immunity, the strain spreading rapidly in the Americas may not be known to African populations and could lead to a more acute disease, the WHO warned. “Vigilance must also be maintained.”

In the current outbreak, Cape Verde is the only African nation to report cases, more than 7,000 of them from October through December 2015. However, the WHO said that, based on available data, the number of cases has been declining since December.

All countries in the African region are at risk for Zika virus transmission, because A. aegypti mosquitoes are widely distributed and transmit several arboviruses on the continent. The WHO said the mosquito has adapted to and flourishes in urban settings found in many African cities, where poor water storage and drainage conditions can increase breeding sites for the mosquitoes.

African countries vary in their access to healthcare and disease detection and management, and ones with strong health systems are likely to cope better with a Zika outbreak, according to the WHO. The agency looked at the vulnerability of 47 countries in the region based on composite measures of hazards, vulnerabilities, and lack of coping capacity.

The WHO said all of the countries are at some risk, but it added that nearly half (20) of the countries were categorized as high risk, with Comoros, Guinea-Bissau, Central African Republic, Madagascar, and South Sudan in the top five. The five countries with the lowest risk were South Africa, Namibia, Swaziland, Mauritius, and Ghana.

The agency urged countries to take actions based on its risk assessment. For example, it said high-risk countries should be prioritized for health system support and vector control investments, and lower-risk countries should receive communication and general advisory support.

What Drug is Best for Preventing Malaria in Pregnancy

In Africa, about 30 million women a year become pregnant in areas where falciparum malaria — the most dangerous kind — is common.

To protect them, health agencies use “intermittent preventive treatment,” or I.P.T., under which all pregnant women in such areas are given doses of anti-malarial drugs at regular intervals, whether or not they are tested for the disease.

But malaria fighters sharply disagree over how to do it, and a recently published by The New England Journal of Medicine adds fuel to the debate.

To cure malaria, virtually everyone in the field uses two-drug cocktails containing, a derivative of the sweet wormwood plant.

But for preventing malaria in pregnant women, the World Health Organization recommends only an older drug combination,  Sulfadoxine-pyrimethamime— also known as Fansidar — even though resistance to it is spreading in Africa.

The new study, led by scientists from Uganda and the University of California, San Francisco, found that women who received sulfadoxine-pyrimethamine for prevention were much more likely to develop malaria symptoms during pregnancy and to have parasites in the placenta when their babies were born.

A similar study done in Kenya and published in The Lancet in 2015 had similar results.

Read: The World’s First Malaria Vaccine to Be Rolled Out in Ghana, Kenya and Malawi in 2018

Some experts believe the W.H.O. should change its recommendation. “To me, it’s shocking that it’s taking so long,” said Dr. Grant Dorsey, who researches malaria at U.C.S.F. and is an author of the Uganda study.

Other malaria-fighting groups are not endorsing change.

The old method is imperfect but still usually prevents deaths, said Dr. Estrella Lasry, a tropical medicine adviser at Doctors Without Borders. Using artemisinin for prevention could speed the emergence of parasites resistant to it.

“We need artemesinin for treatment, so we don’t want to burn it out,” she said.

The President’s Malaria Initiative, the American government’s global malaria-fighting program, which has paid for 42 million doses of I.P.T. since 2005, still thinks the old method protects fetuses well enough to justify continued use, a spokesman said.

The exception is in a small region of East Africa, where the initiative is backing a trial of new methods.

Source: New York Times