ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2022
Prescribed opioid analgesics in early pregnancy and the risk of congenital anomalies: a population-based cohort study.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 17 citations in OpenAlex.
- Increased risk of congenital anomalies after fertility treatment is partially mediated by multiple birth: a population-based cohort study.Human reproduction (Oxford, England) · 2026Article
- Infertility and Risk of Congenital Anomalies: A Population-Based Cohort Study.Paediatric and perinatal epidemiology · 2026Article
- Risk of congenital anomalies among infants of patients with endometriosis: a population-based cohort study.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Article
- Connecting prenatal exposure to paracetamol with postnatal reproductive development: a first of its kind study in reproductive toxicology.Human reproduction open · 2026Article
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Authors and funding
7 authors at 1 institution in 3 countries.
Funding
Abstract
backgroundRecent data suggest an increased risk of congenital anomalies with prenatal exposure to opioid analgesics. We sought to further quantify the risk of anomalies after opioid analgesic exposure during the first trimester in a population-based cohort study.
methodsUsing administrative health data from Ontario, we followed 599 579 gestational parent-infant pairs from singleton pregnancies without opioid use disorder. We identified opioid analgesics dispensed in the first trimester and congenital anomalies diagnosed during the first year of life. We estimated propensity score-adjusted risk ratios (RRs) between first trimester exposure (any opioid analgesic and specific agents) and congenital anomalies (any anomaly, organ system anomalies, major or minor anomalies and specific anomalies).
resultsThe prevalence of congenital anomalies was 2.8% in exposed infants and 2.0% in unexposed infants. Relative to unexposed infants, we observed elevated risks among those who were exposed for some anomaly groups, including gastrointestinal anomalies (any opioid analgesic: adjusted RR 1.46, 95% confidence interval [CI] 1.15-1.85; codeine: adjusted RR 1.53, 95% CI 1.12-2.09; tramadol: adjusted RR 2.69, 95% CI 1.34-5.38) and several specific anomalies, including ankyloglossia (any opioid: adjusted RR 1.88, 95% CI 1.30-2.72; codeine: adjusted RR 2.14, 95% CI 1.35-3.40). These findings persisted in sensitivity analyses.
interpretationAlthough the absolute risk of congenital anomalies was low, our findings add to accumulating data that suggest a small increased risk of some organ system anomalies and specific anomalies with first trimester exposure to opioid analgesics. These findings further quantify the potential risks associated with prenatal exposure to opioid analgesics to inform treatment choices for pain in pregnancy.
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