Persistent postpartum opioid use rare

In countries where postdischarge opioid treatment is generally restricted, postpartum and persistent use of such medications appear to be rare among women giving birth, reports a new Denmark study.

Researchers conducted a national cohort study of 62,520 births in Denmark in 2016, most of which were vaginal deliveries (n=49,859). In comparison, 5,310 were intrapartum caesarean deliveries, while 7,351 were prelabour caesarean deliveries. Danish registries were accessed to assess persistent opioid use, which was defined as ≥3 redeemed prescriptions 31–365 days postpartum.

Out of all the births assessed, only 85 mothers showed persistent postpartum opioid use. Of these, 33 (39 percent) used opioids during pregnancy.

Notably, persistent opioid use was more common among those who had prelabour caesarean births, with an incidence rate of 160 in 100,000. In comparison, the respective incidence rates in women who gave intrapartum caesarean and vaginal deliveries were 38 and 70 in 100,000.

Binary logistic regression analysis confirmed that giving birth via prelabour caesarean delivery was a significant correlate of persistent opioid use (odds ratio [OR], 3.6, 95 percent confidence interval [CI], 2.8–4.6), as opposed to vaginal birth. A similar effect was reported for intrapartum caesarean birth (OR, 2.7, 95 percent CI, 2.0–3.7).

Moreover, the 33 women who took opioids during pregnancy indeed showed a significantly higher propensity of using such medications after discharge (OR, 63.3, 95 percent CI, 43.9–91.4).

“Denmark has universal healthcare with no fees related to general practice visits and around-the-clock services for immediate healthcare issues, also without any fees,” the researchers explained. “The prescription of morphine or other opioids does, however, require an in-person visit which may be a disincentive for women to seek help in obtaining additional analgesics to acetaminophen and ibuprofen.

“We suggest that delivery wards avoid routine opioid prescription and combination opioid medication at discharge from hospital, and instead encourage women to contact their general practitioner should opioid-free analgesics provide inadequate pain relief,” they added.