By Jeanene Swanson -- The use and misuse of prescription opioids by pregnant women has increased from 1.2 per 1,000 hospital live births in 2000 to 5.6 in 2009 in the last 10 years. What\u2019s even more unsettling is that even in light of these statistics, several recent studies have found that doctors are prescribing opioid analgesics to their pregnant patients in growing numbers. Two studies published this spring found an astonishing increase in prescription opioid use\u00a0by pregnant women. (Common opioid analgesics include codeine, hydrocodone and oxycodone.) Of 1.1 million pregnant women on Medicaid, nearly 23 percent filled an opioid prescription in 2007, up from 18.5 percent in 2000,\u00a0according to a study\u00a0led by Rishi Desai of Brigham and Women\u2019s Hospital and Harvard Medical School. Another study, led by Harvard\u2019s Brian Bateman, found that among privately insured pregnant women, 14 percent filled a prescription for opioids\u2014and, only about 10 percent of those were for pain management\u00a0after surgery or those who were addicted to opioids before they\u00a0became pregnant. Pain,\u00a0sometimes severe, is a reality for many women during pregnancy. Weight gain, changes in posture, relaxation of ligaments from hormonal fluctuations and pelvic floor dysfunction can all cause pain. \u201cPregnancy is one of the conditions in which pain complaints are fairly common, especially back pain and abdominal pain,\u201d Desai says. \u201cSo my best guess is, that\u2019s why the women in our cohort were receiving .\u201d However, the majority of the indications for opioid treatment in the Bateman cohort were back pain, abdominal pain, migraine, joint pain and fibromyalgia, all of which are not particularly responsive to opioids and can (and should) be treated with other drugs, including nonsteroidal anti-inflammatory medications, physical therapy, yoga and psychological treatments. Prescription Medications and Birth Defects Opioid use during pregnancy (being addicted to heroin, for instance) is associated with premature delivery, low birth weight, neonatal withdrawal syndrome and birth defects. The Centers for Disease Control and Prevention's Cheryl Broussard led a study published in 2011 examining the effects of opioid pain medications on pregnancy. The study found that \u201ctreatment with opioid analgesics in early pregnancy was linked with several types of congenital heart defects, spina bifida (a neural tube defect), hydrocephaly, glaucoma and gastroschisis (a defect of the belly wall)." The number of babies with these defects made up 3 percent of about 20,000 births. Researchers from Boston University and the CDC found in a 2013 study that mothers who used opioids in the first two months of pregnancy were two times more likely to have a pregnancy affected by a neural tube defect than\u00a0women who didn\u2019t use opioids during pregnancy. Use of prescription medications\u2014and not just opioid analgesics\u2014during pregnancy has skyrocketed; the CDC estimates that today,\u00a0nine out of 10 women in the U.S. take at least one medication while pregnant. According to the Slone Epidemiology Center Birth Defects Study (1976 to 2008) and the National Birth Defects Prevention Study (1997 to 2003), which together interviewed over 30,000 pregnant women about their medication use: \tOver the last three decades, first trimester use of prescription medication increased by over 60 percent. \tUse of four or more medications more than tripled. \tSome of the most commonly used medications during the first trimester are amoxicillin (for infections), progesterone, albuterol (for asthma), and promethazine (for allergies or nausea and vomiting). Some reasons doctors might be prescribing more pain medications may be \u201cincreased awareness of pain control need over the years, changes in physician practice patterns, changes in the prevalence of the underlying pain conditions,\u201d Desai said. Treating Mothers, Treating Addicts Hendree Jones runs a full-service clinic for pregnant addicts. \u201cWe are definitely seeing an increase ,\u201d Jones said, adding that one-third of her patients come in with an opioid addiction, and at least one-half to two-thirds of the women are addicted to\u00a0prescription opioids. While neonatal abstinence syndrome is serious (the incidence increased from 1.2 to 3.4 per 1,000 hospital live births from 2000 to 2009), what many don\u2019t know is that pregnant opiate addicts can carry healthy babies to term. \u201cWe believe that addiction is one part of a woman\u2019s experience,\u201d but not the entirety of it, Jones said. Because pregnant addicts often feel guilty and are stigmatized by healthcare providers, ideally, writes Jones in a recent paper she co-authored, \u201cobstetrical care for pregnant women who use opioids should be provided in the context of comprehensive programs that include prenatal care, specialized drug addiction treatment, mental health care and health education.\u201d Most pregnant women who use opioids in the United States are not enrolled in such programs. Opioid replacement therapy in the form of Suboxone (buprenorphine, a partial opioid agonist) is often better than leaving the addict to detox or worse, go back on the street looking for drugs. \u201cIn some cases, avoiding or stopping medication use during pregnancy may be more harmful than taking a medication,\u201d Broussard said. In fact, writes Jones in her report, \u201cresearch strongly supports maintaining pregnant women on opioid-agonist pharmacotherapy throughout pregnancy and the postpartum period. Medication-assisted withdrawal is associated with a high opioid relapse rate, and some evidence suggests increased fetal morbidity and mortality rates.\u201d All medications have side effects and possible risks. \u201cNo medication that is prescribed during pregnancy is without risk,\u201d Jones said. \u201cProviders and patients have to have really informed conversations.\u201d There might be more of a risk, especially when it comes to pregnant addicts, to not taking a medication. \u201cIt could impact eating, mobility and depression,\u201d Jones said. \u201cAll of those things are risk factors\u201d that could compromise a woman\u2019s ability to deliver a healthy baby. Taking into account the unknowns, and then making an informed decision can go a long way toward helping addicts not only have healthy babies, but also become better parents.