Article at a Glance:

  • Tramadol is an opioid and controlled substance that is commonly prescribed for pain.
  • The drug carries an FDA Black Box Warning for increasing the risk of neonatal abstinence syndrome, a potentially fatal complication in newborns.
  • Tramadol should be avoided during breastfeeding because of an increased risk of overdose in a nursing infant.

Due to possible safety concerns in a fetus, people should avoid using opioids like tramadol during pregnancy. These concerns involve both the possibility of birth defects as well as neonatal opioid withdrawal syndrome if the opioid is taken close to the baby’s birth.

Tramadol is an opioid pain-reliever prescribed to people who suffer from moderate to severe pain, typically from a surgery or injury. Though it contains less opioid content than other prescription drugs — such as oxycodonehydrocodone and morphine — it is still addictive and should be used with caution, especially during pregnancy.

What Is Tramadol?

Tramadol is an opioid pain medication. It may be prescribed to patients who struggle with pain from chronic illnesses, including fibromyalgia, arthritis and cancer. Like all opioids, tramadol works to relieve physical pain by binding to the brain’s opioid receptors and triggering the flow of dopamine. Taking tramadol requires a doctor’s prescription, but even when used as directed, tramadol can still cause a substance use disorder. This makes tramadol a Schedule IV controlled substance.

What Are the Side Effects of Taking Tramadol While Pregnant?

Tramadol’s side effects in a pregnant person are similar to side effects in nonpregnant people. These include:

  • Constipation
  • Nausea and vomiting
  • Dry mouth
  • Indigestion
  • Dizziness
  • Vertigo
  • Headache
  • Drowsiness

However, tramadol crosses the placenta and can cause additional, possibly serious, side effects in your baby.

Can Tramadol Affect Fertility?

Evidence suggests that long-term tramadol use can reduce male fertility. Although some data suggest that female fertility can also be reduced by tramadol, the overall evidence remains unclear.

How Can Tramadol Affect Your Baby?

Because tramadol crosses the placenta, the risks of taking tramadol while pregnant include exposing an unborn baby to the drug. Like other opioids, tramadol carries an FDA Black Box Warning for causing neonatal abstinence syndrome (NAS) in a newborn baby.

Because opioids have been linked to birth defects, doctors will often avoid prescribing tramadol to pregnant women. These include neural tube defects, heart defects, intestinal abnormalities, poor fetal growth, stillbirth and preterm birth.

Does Tramadol Use During Pregnancy Lead to NAS?

Taking tramadol while pregnant can lead to the development of NAS. This condition can occur when an expectant mother consumes opioids, like tramadol, especially in the final months of her pregnancy. NAS can develop in babies whose mothers took large amounts of tramadol to ease prenatal pain or who were addicted to opioids during their pregnancy. In either scenario, prenatal opioid use can cause a baby to be born addicted to drugs and experience severe withdrawal symptoms upon birth. As they can be severe, NAS symptoms often require immediate medical attention and can include:

  • High-pitched crying
  • Excessive sweating
  • Irritability
  • Jitteriness
  • Abnormal muscular activity
  • Seizures

In addition to these painful symptoms, NAS may be responsible for low birth weight, heart defects and various developmental challenges.

Is Tramadol Safe To Use While Breastfeeding?

The FDA states that tramadol is not safe to use during breastfeeding. This is because of the risk of side effects in a nursing baby, including:

  • Excessive sleepiness
  • Problems breastfeeding
  • Slow or shallow breathing
  • Limpness
  • Death

What Are the Risks of Taking Opioids While Pregnant?

Taking opioids while pregnant impacts the mother and fetus together and can put the pregnancy itself at risk. In general, opioid use during pregnancy may increase the risk of:

  • Spontaneous abortion
  • Low birth weight
  • Preeclampsia
  • Premature rupture of membranes

Weighing the Benefits and Risks of Taking Tramadol While Pregnant

Expectant mothers and their doctors must carefully weigh the benefits against the risks of taking opioids like tramadol while pregnant. Although experts recommend avoiding opioids if possible during pregnancy, they recognize that some people may need opioids to control pain.

Ultimately, before a woman chooses to take opioid pain-relievers like tramadol during pregnancy, the mother’s health must be considered alongside the potential risks to her unborn baby.

What Are Some Alternatives to Tramadol for Pain While Pregnant?

Experts recommend that pregnant women should seek out non-pharmacological remedies for pain while pregnant if possible. These can include:

  • Using a heating pad
  • Taking warm baths
  • Eating a balanced diet
  • Engaging in light exercise
  • Investing in massage therapy
  • Attending prenatal yoga classes

If you struggle with an addiction to tramadol, The Recovery Village can help you find the healing you deserve. Call The Recovery Village today to speak with someone who can answer your questions about rehab and guide you toward a program that meets your needs.

a woman wearing glasses and a blazer.
Editor – Melissa Carmona
Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more
a woman wearing glasses and a white robe.
Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more
Sources “Tramadol.” August 17, 2020. Accessed June 22, 2021.

Food and Drug Administration. “FDA Drug Safety Communication: FDA restr[…] breastfeeding women.” March 8, 2018. Accessed June 22, 2021.

American College of Obstetricians and Gynecologists. “Opioid Use and Opioid Use Disorder in Pregnancy,” August 2017. Accessed June 22, 2021.

El-Baky AEA; Hafez MM. “NOS Expression in Oxidative Stress, Neur[…]he Abuse of Tramadol,” Biochemistry and Pharmacology, January 25, 2017. Accessed June 22, 2021.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.