In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to tramadol might increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider.

What is tramadol?

Tramadol is a narcotic prescribed to treat pain. It is in a group of medications called opioids. Ultram® and Conzip® are some brand names for tramadol. Some forms of tramadol can also contain another medication, such as acetaminophen. An example is Ultracet®. For information on acetaminophen, please see https://mothertobaby.org/fact-sheets/acetaminophen-pregnancy/pdf/. These medications are taken by mouth.

I am taking tramadol, but I would like to stop taking it before becoming pregnant. How long does this medication stay in my body?

Always talk with your healthcare provider before making any changes to your medications. In healthy, non-pregnant adults, it usually takes up to two days for tramadol to be gone from your body.

Can taking tramadol make it harder for me to get pregnant?

Studies have not been done to see if taking tramadol could make it harder for you to get pregnant.

I just found out that I am pregnant. Should I stop taking tramadol?

No. If you have been taking tramadol you should not just stop suddenly (also called “cold turkey”). Stopping could cause you to go into withdrawal. Talk with your healthcare provider about the risks and benefits of continuing or stopping your medication. Any reduction in your tramadol should be done slowly, and under the direction of your healthcare provider.

Does taking tramadol during my pregnancy increase the chance of miscarriage?

There is only one small abstract on tramadol and miscarriage. That report did not find a higher chance for miscarriage than among the risk for any woman in the general population to have a miscarriage. Studies are needed to answer this question.

Does taking tramadol increase the chance of having a baby with a birth defect?

Unlikely. There is no confirmed risk for birth defects. One study found no increase in birth defects with tramadol use in the first trimester. However, a second study found an increase in birth defects, including small increases in heart defects and clubfoot. This study did not take into account the reason the mother was taking tramadol. It cannot be known if tramadol was the cause of the birth defects. Studies done on the class of opioid medications have not found a pattern of birth defects to be associated with prenatal opioid use. If there is an increased chance for birth defects with opioid use in pregnancy, it is likely to be small.

Could taking tramadol cause other pregnancy complications?

One study did not find a risk for premature delivery with tramadol use. Studies have not looked to see if there is an increased chance for other pregnancy complications, such as low birth weight or stillbirth. This does not mean that there is a risk, only that studies have not been done to answer this question.

I need to take tramadol throughout my entire pregnancy. Will it cause withdrawal symptoms (neonatal abstinence syndrome) in my baby after birth?

Neonatal abstinence syndrome (NAS) is the term used to describe withdrawal symptoms in newborns if a mother took opioids during pregnancy. There are reports of NAS in infants whose mothers took tramadol during pregnancy. In these reports the mothers had taken tramadol, 200-800 mg, daily throughout pregnancy. NAS symptoms began within the first week of life and included irritability, vomiting, stiff muscles, and a fast heart rate. These reports tell us that NAS can happen with tramadol use during pregnancy. However, these reports do not tell us how often NAS will occur. Babies can be supported through their withdrawal while in the hospital.

Will taking tramadol during pregnancy affect my baby’s behavior or cause learning problems?

Studies have not looked to see if tramadol can affect behavior or learning. This does not mean that there is a risk, only that the question has not been answered.

What do we know about the misuse of opioid medications?

Studies find that pregnant women who take opioids in higher doses or for longer than recommended by their health care providers (i.e. “misuse” or “abuse” opioids) have an increased chance for pregnancy problems. These include poor growth of the baby, stillbirth, premature delivery, and c-section. Some women who abuse opioids also have other habits that can result in health problems for both the mother and the baby. For example, poor diet choices can lead to mothers not having enough nutrients to support a healthy pregnancy and could increase the chance of miscarriage or premature birth. Sharing needles to inject opioids increases the risk of getting diseases like hepatitis C and/or HIV, which can cross the placenta and infect the baby.

Can I breastfeed my baby if I am taking tramadol?

Tramadol has been found to enter breast milk in low amounts. A study of 75 newborns whose mother took tramadol for c-section pain found no extra problems compared to other opioid medications that the mother took after delivery.

However, the FDA recommends that tramadol not be used during breastfeeding due to concerns that the medication could build up in the baby’s system and cause problems, such as difficulty breathing or not waking to feed. If tramadol is used during breastfeeding, the baby should be watched very carefully for any signs of being very sleepy or having a hard time breathing. The baby’s health care provider should be contacted right away if your baby has any problems. Be sure to talk to your health care provider about all your breastfeeding questions.

What if the baby’s father takes tramadol?

Studies have not looked at the father’s use of tramadol. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/pdf/.

References Available Upon Request