Tramadol
Avoid in pregnancy. Tramadol is a synthetic opioid and norepinephrine-serotonin reuptake inhibitor. Associated with Neonatal Opioid Withdrawal Syndrome (NOWS) and neonatal seizures when used near delivery. Contraindicated during breastfeeding (FDA 2017, same warning as codeine). No established teratogenicity at therapeutic doses but risk-benefit strongly favors alternatives.