Medically Reviewed

Is it Safe to Use Ketamine During Pregnancy?

Is it Safe to Use Ketamine During Pregnancy?

Ketamine is a prescription medication used for starting and maintaining general anesthesia in both humans and animals. It is also used to treat certain cases of chronic pain and treatment-resistant depression.1-2 Ketamine is also a popular recreational party drug due to its powerful dissociative and psychedelic effects. Although ketamine is seeing increased use both recreationally and as an antidepressant therapeutic, there are still risks associated with the use of this drug. This is especially true for an expecting mother and her unborn child.

Ketamine is typically not recommended for use during pregnancy due to a lack of data from controlled studies in humans. For this same reason, the Federal Drug Administration has not assigned a pregnancy risk category to ketamine. Because it currently remains unclassified, it is best to avoid ketamine use while pregnant unless you are directed to do so by your doctor.

How Does Ketamine Affect a Fetus?

It has been known for decades that ketamine can pass from human mothers to fetus through the blood-placental barrier.3 In addition, several recent animal studies suggest that prenatal and early postnatal exposure to ketamine can be neurotoxic to the developing brain.

A study published in 2016 found that exposure to ketamine during pregnancy in rats resulted in reduced neuronal development of certain brain regions in the offspring.4 Several studies conducted at the Northeast Agricultural University College of Veterinary Medicine in China found that the offspring of pregnant rats treated with ketamine had long-term neurocognitive abnormalities, including impaired learning and memory abilities.5-6 Another study showed that prenatal exposure to ketamine causes damage to the prefrontal cortex of the brain that is associated with abnormal behavior in offspring, including depression and anxiety.7-8

To better resemble the potential effects of ketamine in unborn humans, studies have also been performed using non-human primates. Studies conducted in Rhesus macaques, a species of monkeys, have shown that ketamine use during pregnancy causes neurodegeneration in the fetal brain.9 Another study showed Rhesus monkeys that had undergone a single administration of intravenous ketamine anesthesia during the first week of life exhibited long-lasting significant cognitive deficits.10

Although the FDA has not assigned ketamine to a pregnancy risk category, the pharmaceutical provider of Spravato, the ketamine nasal spray approved for treating depression, has recently warned of the potential risk of fetal toxicity if the drug is administered to pregnant women.11 Ketamine use should therefore be avoided in pregnant women.

Treatment Options

If you currently use ketamine and are pregnant or considering getting pregnant you should beware of the potential risks to your unborn baby. If you are psychologically dependent on ketamine you should not stop suddenly, as this can cause you to go into withdrawal. Talk with your doctor or other healthcare providers for advice on how to slowly stop taking ketamine. Individualized treatment programs for ketamine addiction, including both inpatient and outpatient care, are also available through rehab facilities. A medical detox in a hospital or treatment center will address any withdrawal symptoms and help to make the process as safe and comfortable as possible.

Sources

  1. Bell, R.F., & Kalso, E.A. (2018). Ketamine for pain management. PAIN Reports, 3(5), e674.
  2. U.S. Food and Drug Administration. (2019). FDA approves new nasal spray medication for treatment-resistant depression; available only at a certified doctor’s office or clinic.
  3. Ellingson, A., Haram, K., and Solheim, E. (1977). Transplacental passage of ketamine after intravenous administration. Acta Anaesthesiologica Scandinavica, 21(1), 41-44.
  4. Dong, C., Rovnaghi, C.R., & Anand, K.J. (2016). Ketamine exposure during embryogenesis inhibits cellular proliferation in rat fetal cortical neurogenic regions. Acta Anaesthesiologica Scandinavica, 60(5), 579–587.
  5. Li, X., Guo, C., Li, Y., Li, L., Wang, Y., Zhang, Y., …& Gao, L. (2017). Ketamine Administered Pregnant Rats Impair Learning and Memory in Offspring via the CREB Pathway. Oncotarget, 8(20), 32433-32449.
  6. Li, Y., Li, X., Guo, C., Li, L., Wang, Y., Zhang, Y., …& Gao, L. (2017). Long-Term Neurocognitive Dysfunction in Offspring via NGF/ ERK/CREB Signaling Pathway Caused by Ketamine Exposure during the Second Trimester of Pregnancy in Rats. Oncotarget, 8(19), 30956-30970.
  7. Zhao, T., Li, Y., Wei, W., Savage, S., Zhou, L., & Ma, D. (2014). Ketamine administered to pregnant rats in the second trimester causes long-lasting behavioral disorders in offspring. Neurobiology of Disease, 68, 145-155.
  8. Zhao, T., Li, C., Wei, W., Zhang, H., Ma, D., Song, X., & Zhou, L. (2016). Prenatal ketamine exposure causes abnormal development of prefrontal cortex in rat. Scientific Reports, 6(26865).
  9. Brambrink, A.M., Evers, A.S., Avidan, M.S., Farber, N.B., Smith, D.J., Martin, L.D., …& Olney, J.W. (2012). Ketamine-induced neuroapoptosis in the fetal and neonatal rhesus macaque brain. Anesthesiology, 116(2), 372-384.
  10. Paule, M. G., Li, M., Allen, R. R., Liu, F., Zou, X., Hotchkiss, C., et al. (2011). Ketamine anesthesia during the first week of life can cause long-lasting cognitive deficits in rhesus monkeys. Neurotoxicology and Teratology, 33(2), 220–230.
  11. Janssen Pharmaceuticals. (2019). Spravato.
Last Updated on October 30, 2019
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