Opioid prescription during pregnancy ups risk of new persistent opioid use

Pregnant women who receive an opioid prescription tend to experience new persistent opioid use, results of a study have shown.

Patients aged 12–55 years in Optum’s deidentified Clinformatics Data Mart Database who underwent vaginal or caesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year after discharge, were included in this nationwide retrospective cohort study.

Women were eligible if they were opioid naïve in pregnancy and did not undergo a procedure within the year after discharge. Filling an opioid prescription during pregnancy was the exposure. The authors performed descriptive statistics and multivariate logistic regression analyses, adjusting for clinical and demographic covariates.

A total of 158,425 childbirths were identified, of which 101,013 (63.8 percent) were by vaginal delivery and 57,412 (36.2 percent) caesarean delivery. Six percent (n=9,429) of the women filled an opioid prescription during pregnancy.

Having a nondelivery procedure in pregnancy (adjusted odds ratio [AOR], 9.60, 95 percent confidence interval [CI], 8.81–10.47) and having an emergency room visit during pregnancy (AOR, 2.48, 95 percent CI, 2.37–2.59) were associated with filling an opioid prescription in pregnancy.

New persistent opioid use developed in 4 percent (n=379) of women who received an opioid during pregnancy. Factors associated with new persistent opioid use were receiving an opioid prescription during pregnancy (AOR, 3.45, 95 percent CI, 3.04–3.92) and filling a peripartum opioid prescription 1 week prior to 3 days postdischarge (AOR, 2.28, 95 percent CI, 2.02–2.57).

Although having a procedure during pregnancy correlated with increased receipt of an opioid prescription, it also reduced new persistent opioid use (AOR, 0.72, 95 percent CI, 0.52–0.99).

“Maternity care providers must balance pain management in pregnancy with potential risks of opioids,” the authors said.