Trigger point injections are not strictly off-limits during pregnancy, but they come with enough caveats that the decision requires careful consideration of what’s being injected, where, and how far along you are. Pregnancy is listed as a relative contraindication for both trigger point injections and dry needling, meaning it’s not an absolute “no” but a reason for extra caution.
Why Pregnancy Complicates the Decision
The concern isn’t really about the needle itself. It’s about the substances injected, the body’s changed physiology, and the potential for complications that carry higher stakes when you’re pregnant. Your blood volume increases, your immune system shifts, and your body responds differently to medications and even to lying in certain positions. All of this matters when a provider is deciding whether to proceed.
There’s also the simple reality that most studies on trigger point injections exclude pregnant women, so the safety data is limited. Providers are often working from general medication safety profiles and clinical judgment rather than direct evidence in pregnant populations.
What’s in the Injection Matters
Trigger point injections typically contain a local anesthetic like lidocaine, sometimes combined with a corticosteroid or saline. Each ingredient carries a different risk profile during pregnancy.
Lidocaine, the most common anesthetic used, has not been shown to increase the chance of birth defects. However, there are isolated case reports of side effects in newborns when lidocaine was used close to delivery, including low muscle tone, breathing difficulty, and seizures. Whether lidocaine affects the risk of preterm delivery or low birth weight remains unknown. For a small, localized injection into a muscle (as opposed to a large epidural dose), the amount of lidocaine entering your bloodstream is relatively small, but it does cross the placenta.
Corticosteroids raise a different set of questions. Early studies suggested that first-trimester corticosteroid use might increase the risk of cleft lip, with one meta-analysis putting the odds ratio at 3.4. More recent studies, though, have not replicated those findings, and the estimated real-world risk increase is modest: from about 1.7 per 1,000 live births to roughly 2.7 per 1,000. Systemic corticosteroid use in pregnancy does not appear to independently increase the risk of preterm birth, low birth weight, or preeclampsia based on current evidence. That said, trigger point injections typically use very small, localized doses of corticosteroids, so systemic exposure is minimal compared to oral steroid therapy.
Epinephrine Should Be Avoided
Some trigger point injection formulations include epinephrine to prolong the anesthetic effect. In pregnancy, this is a concern. Animal research has shown that epinephrine causes a 38.5% decrease in total uterine blood flow, with an even sharper 58.7% drop in blood flow to the uterine lining. Blood flow to the placenta dropped by about 34.5%. Reduced placental blood flow means less oxygen and fewer nutrients reaching the baby. If you do receive trigger point injections while pregnant, formulations without epinephrine are strongly preferred.
Positioning During the Procedure
After about 24 weeks of pregnancy, lying flat on your back can cause the weight of the uterus to compress a major vein (the inferior vena cava), reducing blood flow back to your heart. This is called supine hypotensive syndrome, and it can cause dizziness, nausea, and a sudden drop in blood pressure. Symptoms resolve quickly by rolling onto your left side, but the situation is best avoided entirely.
For trigger point injections that require you to lie down, a left pelvic tilt of at least 30 degrees using a wedge cushion can prevent this problem. If you’re past 24 weeks and your provider doesn’t mention positioning, bring it up yourself.
Risks Beyond the Medication
Trigger point injections carry procedural risks that aren’t unique to pregnancy but become more consequential during it. The most common side effect is soreness or swelling at the injection site, which resolves on its own. Rare but serious complications include pneumothorax (a punctured lung, most relevant for injections near the chest or upper back), infection at the injection site, and nerve injury. One published case involved a 37-year-old woman who was 20 weeks pregnant and developed a retrosternal abscess after repeated trigger point injections near the sternoclavicular joint. She had previously experienced a pneumothorax from the same procedure.
These severe complications are uncommon in the general population, but during pregnancy, treating them becomes more complex. Imaging options are limited, certain antibiotics are restricted, and surgical interventions carry additional risks for the pregnancy.
Dry Needling as an Alternative
Dry needling uses the same type of thin needle but without injecting any substance. Research has consistently shown that the pain-relieving effect of trigger point needling comes primarily from the needle itself, not from whatever is injected. A Cochrane review found dry needling to be a useful addition to other therapies for chronic low back pain, and a review of 23 randomized controlled trials concluded that improvement was similar regardless of what substance was injected.
This makes dry needling appealing during pregnancy because it eliminates concerns about lidocaine crossing the placenta, corticosteroid effects on development, and epinephrine reducing uterine blood flow. However, pregnancy is still listed as a relative contraindication for dry needling, largely due to the lack of direct safety studies in pregnant women and the general procedural risks of needling (soreness, bruising, rare nerve irritation). Some physical therapists will perform dry needling during the second and third trimesters on a case-by-case basis, while others decline entirely.
Other Options for Myofascial Pain
Given the uncertainties, many providers recommend trying non-invasive approaches first. Manual trigger point release (sustained pressure applied by a physical therapist’s hands), prenatal massage, stretching programs, and heat therapy can all reduce myofascial pain without introducing needles or medications. These carry essentially no risk to the pregnancy.
If those approaches aren’t enough, a saline-only injection (sometimes called a “wet needling” with normal saline) offers a middle ground. Studies have shown that saline injections into trigger points produce pain relief comparable to lidocaine injections, removing the question of anesthetic safety entirely. Not all providers offer this option, so it’s worth asking about specifically.
The trimester matters, too. Most providers are more cautious during the first trimester, when fetal organ development is most active and vulnerability to outside exposures is highest. The second trimester is generally considered the lowest-risk window for elective procedures, while the third trimester reintroduces concerns about preterm labor and medication effects close to delivery.