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Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MIInstitute for Health Policy and Innovation, University of Michigan, Ann Arbor, MINational Clinician Scholars Program, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MIInstitute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MIInstitute for Health Policy and Innovation, University of Michigan, Ann Arbor, MIProgram on Women’s Health Care Effectiveness Research (PWHER), University of Michigan, Ann Arbor, MI
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MIInstitute for Health Policy and Innovation, University of Michigan, Ann Arbor, MIUniversity of Michigan Medical School, Department of Psychiatry, Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan School of Public Health, and the Institute for Social Research, University of Michigan, Ann Arbor, MI
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MIInstitute for Health Policy and Innovation, University of Michigan, Ann Arbor, MISchool of Nursing, Women’s Studies Department, University of Michigan, Ann Arbor, MI
Program on Women’s Health Care Effectiveness Research (PWHER), University of Michigan, Ann Arbor, MIMichigan Opioid Prescribing Engagement Network, Ann Arbor, MIDepartment of Surgery, University of Michigan, Ann Arbor, MI
To evaluate the association between opioid prescribing during pregnancy and new persistent opioid use in the year following delivery.
Materials and Methods
This nationwide retrospective cohort study included patients aged 12−55 years in Optum’s deidentified Clinformatics Data Mart Database who were undergoing vaginal delivery or cesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year postdischarge. Women were included if they were opioid naive in pregnancy (ie, did not fill an opioid prescription 2 years to 9 months before delivery) and did not undergo a procedure within the year after discharge. The exposure was filling an opioid prescription in pregnancy. The primary outcome was new persistent opioid use, defined as a pharmacy claim for ≥1 opioid prescription between 4 and 90 days postdischarge and ≥1 prescription between 91 and 365 days postdischarge. Clinical and demographic covariates were included. Analyses included descriptive statistics and multivariable logistic regression, adjusting for clinical and demographic covariates.
Results
Of 158,425 childbirths identified, 101,013 (63.8%) were by vaginal delivery and 57,412 (36.2%) cesarean delivery. Among all patients, 6.0% (9429) filled an opioid prescription during pregnancy. The factors associated with filling an opioid in pregnancy were having a nondelivery procedure in pregnancy (adjusted odds ratio, 9.60; 95% confidence interval, 8.81−10.47) and having an emergency room visit during pregnancy (adjusted odds ratio, 2.48; 95% confidence interval, 2.37−2.59). Of women who received an opioid in pregnancy, 4% (379) developed new persistent opioid use. The factors most associated with new persistent opioid use were receiving an opioid prescription during pregnancy (adjusted odds ratio, 3.45; 95% confidence interval, 3.04−3.92) and filling a peripartum opioid prescription (1 week prior to 3 days postdischarge) adjusted odds ratio, 2.28, 95% confidence interval (2.02−2.57). Though having a procedure during pregnancy was associated with increased receipt of an opioid prescription, it was also associated with reduced new persistent opioid use (adjusted odds ratio, 0.72; 95% confidence interval, 0.52−0.99).
Conclusion
Women who receive an opioid prescription during pregnancy are more likely to experience new persistent opioid use. Maternity care providers must balance pain management in pregnancy with potential risks of opioids.
As maternity care providers have recognized the role of peripartum opioid prescribing in the opioid epidemic, reducing opioid prescribing following delivery has become a national priority.
This increased focus is warranted, as 1 in 75 women in the United States who fill an opioid prescription in the peripartum period will continue filling prescriptions up to 1 year postpartum.
In fact, exposure to postpartum opioids has been linked to new persistent use after delivery, independent of the type of birth (vaginal vs cesarean delivery), suggesting that the risk is inherent to the opioid prescription.
Between 14% and 22% of patients fill an opioid prescription in pregnancy; however, little is known about the consequences of this acute prescribing in pregnancy. We evaluated rates of new persistent opioid use (NPOU) after delivery in opioid-naive women who received an opioid prescription during pregnancy, and the factors most associated with NPOU.
Key findings
In opioid-naive patients who received an acute opioid prescription during pregnancy, 4% developed new persistent opioid use in the year after delivery. Filling an opioid in pregnancy and postpartum were associated with NPOU, whereas having surgery in pregnancy was associated with lower NPOU.
What does this add to what is known?
These data suggest that opioid prescribing during pregnancy poses a risk of postpartum persistent opioid use. Maternity providers will need to consider how to best balance adequate pain management in pregnancy with the risk of long-term opioid harms.
Less is known, however, about the long-term consequences of acute opioid prescribing during pregnancy, outside of the delivery episode. It is possible that opioid prescribing for pain in pregnancy could have an effect similar to that of postpartum opioid prescribing. Women may experience pain from physiologic changes of pregnancy (eg, round ligament pain), recurrence of chronic conditions (eg, back pain), or pathologic pain related to new conditions (eg, appendicitis).
Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice.
Pain management in pregnancy must balance risks to both the pregnant woman and the fetus. As opioid alternatives like nonsteroidal anti-inflammatory drugs (NSAIDS) may cause fetal complications including miscarriage and renal dysfunction,
pregnant patients may be more likely to receive opioids because of potential differences in safety profile during pregnancy. However, there is a growing body of evidence that acute opioid exposure can lead to long-term use.
To understand the effects of opioid prescribing during maternity care, we assessed rates of opioid prescribing during pregnancy and their impact on long-term opioid use following delivery in opioid-naive patients.
Materials and Methods
In this retrospective cohort study, we analyzed claims from a national single private payer including medical and prescription drug coverage, aggregated in Optum’s deidentified Clinformatics Data Mart Database. We included women aged 12−55 years who underwent vaginal or cesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year after discharge. We selected patients with 2 years of continuous enrollment prior to delivery in order to identify women who were opioid naive in the year prior to pregnancy. Similarly, we required an additional year of enrollment postpartum to assess opioid use in the year following delivery. Women were excluded if they met the following criteria: (1) filled an opioid prescription from 2 years to 9 months before delivery admission (ie, were not opioid naive in the year before pregnancy); (2) underwent a procedure as identified by anesthesia codes within 1 year of discharge; or (3) had an index hospitalization length of stay (defined as time from cesarean delivery to discharge) of >7 days, as these deliveries were not thought to represent routine care. If patients had multiple deliveries in the specified time period, only the first birth was included.
The main exposure in this analysis was filling an opioid prescription in pregnancy. The primary outcome was new persistent opioid use (NPOU) after vaginal or cesarean delivery, defined as at least 2 pharmacy claims after discharge: ≥1 opioid prescription between 4 and 90 days postdischarge and ≥1 prescription between 91 and 365 days postdischarge.
This definition of NPOU is consistent with prior work, and represents a time when patients are expected to have recovered from their initial delivery episode.
To assess the factors associated with filling an opioid prescription during pregnancy and developing NPOU, we included demographic and clinical characteristics as covariates in adjusted models. Demographic variables included age, race/ethnicity, education, region, and year of delivery. Clinical characteristics included pregnancy comorbidities as measured by the Bateman comorbidity index,
delivery type (vaginal vs cesarean), and delivery-specific complications/additional procedures defined by billing codes for both vaginal delivery (eg, prolonged labor, bilateral tubal ligation) and cesarean delivery (eg, unscheduled delivery and repeat cesarean). Characteristics of opioid exposure during pregnancy included receipt of an opioid prescription during pregnancy and oral morphine equivalents prescribed. We also report whether patients received a peripartum opioid prescription (defined as 1 week prior to 3 days after discharge), as this has previously been independently associated with NPOU.
Healthcare use measures including emergency department visits, inpatient hospitalizations, and procedures in pregnancy (as defined by nondelivery anesthesia codes) were also included as dichotomous variables. To determine the diagnoses associated with opioid prescriptions, we reported the diagnosis codes from encounters 3 days prior to prescription fills, with a frequency of ≥50 across the included population.
Analyses included descriptive statistics for cohort characteristics, rates of opioid prescription fills in pregnancy, diagnoses associated with opioid prescriptions, and rates of NPOU. Multivariable logistic regression models were used to separately estimate the adjusted odds ratio (aOR) for filling an opioid prescription in pregnancy and developing NPOU. We also conducted a sensitivity analysis using 2 additional definitions of NPOU from the literature: (1) Brummett et al defined NPOU in patients undergoing major and minor procedures as ≥2 opioid prescriptions filled after the perioperative period, ≥1 prescription before 90 days, and ≥1 prescription between 90 and 180 days postdischarge; and (2) Bateman et al defined NPOU as ≥1 opioid prescription filled in at least 4 of 12 months after the perioperative period to 365 days after discharge.
All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Statistical significance was set at P < .05 with 2-sided tests. This study was deemed exempt by the University of Michigan Institutional Review Board.
Results
We identified 988,036 women who underwent vaginal or cesarean delivery from 2008 to 2016, of whom 158,425 met inclusion criteria (101,013 [63.8%] vaginal deliveries; 57,412 [36.2%] cesarean deliveries) (Figure 1). Descriptive data for the cohort are presented in Table 1. Among all deliveries, 6.0% of the women (9429) filled an opioid in pregnancy (vaginal deliveries, 5.6% [5619]; cesarean deliveries, 6.6% [3810]). Of patients who filled an opioid prescription during pregnancy, the median OMEs per patient was 108 (interquartile range [IQR] 81−146), and 16% filled ≥2 prescriptions during pregnancy (range 1−22 prescriptions in pregnancy). Only 1.8% (2871) of patients in the cohort had a procedure with anesthesia during pregnancy.
Figure 1Flowchart of patient inclusions and exclusions
Patients were more likely to receive an opioid prescription during pregnancy if they received nondelivery anesthesia (aOR, 9.60; 95% confidence interval [CI], 8.81−10.47), presented for an emergency room visit (aOR, 2.48; 95% CI, 2.37−2.59) or underwent an inpatient hospitalization (aOR, 1.92; 95% CI, 1.78−2.08). Women who used tobacco (aOR, 1.48; 95% CI, 1.37−1.60), had comorbid psychiatric diagnoses such as mood disorders (aOR, 1.23; 95% CI, 1.13−1.33), and had comorbid pain disorders such as back pain (aOR, 1.57; 95% CI, 1.48−1.65), were also more likely to receive an opioid prescription than women without these characteristics (Table 2). The most common diagnoses associated with receiving an opioid in pregnancy were abdominal pain (4278 [14.5%]), urinary tract infections (1997 [6.8%]), and back pain (1470 [6.3%]). Diagnoses associated with opioid prescriptions were unspecified for 10,071 (34.2%).
Table 2Logistic regression model for filling an opioid prescription during pregnancy
Characteristic
Vaginal delivery cohort (n = 101,013)
Cesarean delivery cohort (n = 57,412)
Vaginal delivery and cesarean delivery combined cohort (n = 158,425)
Adjusted OR
95% CI
P value
Adjusted OR
95% CI
P value
Adjusted OR
95% CI
P value
Age, y
20−29 (reference)
1
NA
NA
1
NA
NA
1
NA
NA
<20
0.88
(0.77-1.02)
0.081
0.88
(0.69-1.11)
0.281
0.88
(0.78-0.99)
0.035
30−39
0.93
(0.87-0.99)
0.023
0.93
(0.86-1.01)
0.081
0.94
(0.89-0.98)
0.008
≥40
0.92
(0.79-1.07)
0.280
0.97
(0.84-1.12)
0.683
0.96
(0.86-1.06)
0.403
Race/ethnicity
White (reference)
1
NA
NA
1
NA
NA
1
NA
NA
Black
1.06
(0.96-1.18)
0.260
0.99
(0.88-1.13)
0.900
1.04
(0.96-1.12)
0.389
Hispanic
0.77
(0.69-0.85)
<.001
0.79
(0.70-0.89)
<.001
0.78
(0.72-0.84)
<.001
Asian
0.84
(0.74-0.96)
0.008
0.81
(0.70-0.94)
0.005
0.83
(0.76-0.92)
<.001
Unknown
0.93
(0.87-1.00)
0.044
0.92
(0.84-1.00)
0.046
0.93
(0.88-0.98)
0.006
Region
Northeast (reference)
1
NA
NA
1
NA
NA
1
NA
NA
Midwest
1.93
(1.70-2.18)
<.001
1.81
(1.57-2.09)
<.001
1.87
(1.70-2.05)
<.001
South
2.29
(2.04-2.58)
<.001
2.15
(1.89-2.45)
<.001
2.23
(2.05-2.44)
<.001
West
2.27
(2.01-2.58)
<.001
2.07
(1.79-2.38)
<.001
2.18
(1.98-2.39)
<.001
Unknown
3.50
(2.23-5.51)
<.001
1.27
(0.51-3.19)
0.606
2.66
(1.78-3.97)
<.001
Education level
Less than bachelor degree (reference)
1
NA
NA
1
NA
NA
1
NA
NA
Less than 12th grade
0.96
(0.65-1.42)
0.821
1.11
(0.70-1.76)
0.650
1.02
(0.76-1.38)
0.890
High school diploma
1.07
(0.99-1.15)
0.077
1.09
(0.99-1.19)
0.071
1.08
(1.02-1.14)
0.010
Bachelor degree plus
0.84
(0.78-0.91)
<.001
0.95
(0.87-1.03)
0.206
0.88
(0.83-0.93)
<.001
Unknown
0.93
(0.68-1.26)
0.628
0.88
(0.60-1.29)
0.508
0.91
(0.72-1.16)
0.449
Delivery year
2008
1
NA
NA
1
NA
NA
1
NA
NA
2009
0.99
(0.89-1.09)
0.796
1.01
(0.89-1.14)
0.856
1.00
(0.92-1.08)
0.949
2010
1.03
(0.93–1.14)
.600
1.06
(0.93–1.20)
.372
1.04
(0.96–1.13)
.295
2011
0.98
(0.88–1.09)
.741
0.94
(0.82–1.07)
.322
0.97
(0.89–1.05)
.392
2012
0.83
(0.74–0.93)
.001
0.91
(0.80–1.04)
.168
0.86
(0.79–0.94)
<.001
2013
0.83
(0.74–0.93)
.001
0.78
(0.67–0.90)
.001
0.81
(0.74–0.88)
<.001
2014
0.60
(0.53–0.68)
<.001
0.64
(0.55–0.75)
<.001
0.62
(0.56–0.68)
<.001
2015
0.55
(0.48–0.63)
<.001
0.59
(0.50–0.69)
<.001
0.57
(0.51–0.63)
<.001
2016
0.53
(0.46–0.61)
<.001
0.56
(0.47–0.66)
<.001
0.54
(0.49–0.60)
<.001
Tobacco use
1.48
(1.34–1.64)
<.001
1.46
(1.30–1.65)
<.001
1.48
(1.37–1.60)
<.001
Psychiatric diagnoses
Adjustment disorder
1.06
(0.92–1.22)
.455
1.03
(0.87–1.21)
.763
1.04
(0.94–1.16)
.443
Anxiety disorder
1.04
(0.94–1.15)
.483
1.18
(1.05–1.33)
.005
1.10
(1.02–1.18)
.020
Mood disorder
1.27
(1.14–1.41)
<.001
1.17
(1.03–1.33)
.015
1.23
(1.13–1.33)
<.001
Substance use disorder
1.16
(0.98–1.38)
.088
1.29
(1.06–1.58)
.013
1.21
(1.06–1.38)
.004
Pain condition
Arthritis
1.14
(1.07–1.22)
<.001
1.13
(1.04–1.23)
.003
1.13
(1.08–1.19)
<.001
Back
1.57
(1.46–1.68)
<.001
1.56
(1.43–1.71)
<.001
1.57
(1.48–1.65)
<.001
Neck
0.95
(0.86–1.04)
.288
0.90
(0.80–1.01)
.073
0.93
(0.87–1.00)
.054
Other pain
1.44
(1.35–1.53)
<.001
1.47
(1.37–1.59)
<.001
1.45
(1.38–1.52)
<.001
Bateman comorbidity index
1.02
(1.00–1.05)
.045
1.02
(1.00–1.04)
.077
1.03
(1.01–1.04)
.002
Emergency room visit during pregnancy
2.59
(2.44–2.75)
<.001
2.31
(2.15–2.48)
<.001
2.48
(2.37–2.59)
<.001
Inpatient during pregnancy
2.07
(1.87–2.30)
<.001
1.73
(1.54–1.96)
<.001
1.92
(1.78–2.08)
<.001
Any procedure requiring anesthesia during pregnancy
10.96
(9.72–12.37)
<.001
8.23
(7.27–9.32)
<.001
9.60
(8.81–10.47)
<.001
CI, confidence interval; NA, not applicable; OR, odds ratio.
Peahl et al. Acute opioid prescribing in pregnancy. Am J Obstet Gynecol 2020.
Of patients who received an opioid in pregnancy, 4.0% (379) developed NPOU. Of those undergoing vaginal birth who received an opioid during pregnancy, 3.2% (179) had postpartum NPOU. Among women undergoing cesarean delivery who received an opioid during pregnancy, 5.2% (200) had postpartum NPOU. Rates of NPOU after vaginal delivery and cesarean delivery in women who did not receive an opioid prescription in pregnancy were 0.6% (545) and 1.3% (682), respectively.
We identified several risk factors associated with NPOU (Figure 2). Women were more likely to develop NPOU if they received an opioid during pregnancy (aOR, 3.45; 95% CI, 3.04−3.92) or filled a peripartum opioid prescription (aOR, 2.28; 95% CI, 2.02−2.57). Whereas having an emergency department visit during pregnancy was associated with NPOU (aOR, 1.19; 95% CI, 1.06−1.33), inpatient hospitalization was not (aOR, 1.15; 95% CI, 0.94−1.42). Although undergoing a procedure in pregnancy was the factor most strongly associated with filling an opioid prescription, it was associated with a decreased rate of NPOU after delivery (aOR, 0.72; 95% CI, 0.52−0.99). Patients who had lower education, history of substance abuse, and cesarean delivery were also more likely to have NPOU.
Figure 2Plot of adjusted odds ratios of characteristics associated with new persistent opioid use after delivery
NPOU after delivery was higher in patients who filled an opioid prescription during pregnancy across all definitions of NPOU included in the sensitivity analysis. Even using the most conservative definition of new persistent opioid use,
rates were higher in women with opioid use during pregnancy compared to those without (vaginal delivery and cesarean delivery combined: 1.2% [115] vs 0.1% [176]; vaginal delivery 1.2% [70] vs 0.1% [96]; cesarean delivery 1.2% [45] vs 0.1% [80]) (P < .01 for all comparisons).
Comment
Principal findings
In our study, receipt of an opioid prescription during pregnancy was independently associated with new persistent opioid use in the year following delivery. Undergoing a procedure with anesthesia was most strongly associated with receiving an opioid prescription during pregnancy, but with lower rates of NPOU. In contrast, emergency department visits were associated with both receipt of an opioid prescription in pregnancy and NPOU. We also confirmed factors previously associated with NPOU, including prescription factors (eg, filling a peripartum prescription) and individual factors (eg, younger age, lower education, race/ethnicity, tobacco use, and psychiatric and pain diagnoses).
Going forward, future efforts targeting opioid reduction throughout pregnancy, in addition to the peripartum period, are critical to reduce the long-term harms of opioid exposure.
We included in our study only women who were opioid naive in the year before pregnancy and had 3 years of continuous enrollment to isolate the independent effect of opioid prescribing during pregnancy. These criteria explain the lower rates of opioid prescribing seen in our population when compared to those in previous groups. Thus, our findings likely underestimate national rates of NPOU, as prior work has demonstrated higher rates of prescribing for patients who have Medicaid or are not opioid naive prior to pregnancy.
Thus, almost 1 in 5 women in the general population are exposed to opioids during pregnancy, a particularly vulnerable period often associated with stress and anxiety that may further potentiate the risk of prolonged use.
There are many potential consequences of opioid prescribing in pregnancy for both women and their children. For women who are opioid naive, opioid prescribing can be associated with NPOU and greater risk for opioid harms in the future.
In addition, some data suggest a possible increased risk of neural tube defects, congenital heart defects, and gastroschisis in fetuses exposed to opioids during the first trimester.
Exposure to opioids near the time of birth may also contribute to neonatal abstinence syndrome, neonatal intensive care unit admissions, and potential neurodevelopmental effects.
Prenatal risk factors and perinatal and postnatal outcomes associated with maternal opioid exposure in an urban, low-income, multiethnic US population.
Although adequate pain management must be a priority, approaches should also balance the potential maternal and fetal risks and benefits of treatment.
Research implications
Although there are now clear recommendations for postdelivery prescribing for pregnant women, current recommendations for pain management in pregnancy provide little guidance on appropriate management of acute pain.
There are several reasons for this omission: (1) efforts to reduce postoperative prescribing in other surgical specialties have paved the way for postdelivery recommendations but have not been as well developed for prenatal pain management; (2) there are potential concerns about the safety of opioid alternatives (such as NSAIDs and acetaminophen) in pregnancy. There are data linking use of NSAIDs with complications in the third trimester, including premature closure of the ductus arteriosus and oligohydramnios from impaired renal function.
In contrast, the validity of studies that associate NSAIDs with miscarriage and acetaminophen with increased rates of attention-deficit/hyperactivity disorder (ADHD) is limited by recall bias and inadequate adjustment for confounding.
Prenatal risk factors and perinatal and postnatal outcomes associated with maternal opioid exposure in an urban, low-income, multiethnic US population.
Association of cord plasma biomarkers of in utero acetaminophen exposure with risk of attention-deficit/hyperactivity disorder and autism spectrum disorder in childhood.
Nonetheless, in the absence of robust safety data, providers may resort to using opioids for acute pain, although these medications are not without harm. Acute pain management guidelines will require a clearer understanding of the actual risks of nonopioid medications, and the potential benefits of nonpharmacologic treatments for acute pain such as deep breathing, visualization, massage, and physical therapy in the context of pregnancy.
In our study, the most common diagnoses associated with opioid prescription fills in pregnancy were unspecified, or attributable to visits for nonspecific abdominal pain, urinary tract symptoms, and back pain. It is difficult to assess which of these indications is “appropriate” for opioid prescribing, particularly because we cannot see alternative pain strategies used by patients: opioid-sparing medications are frequently prescribed over the counter, and nonpharmacologic regimens leave no footprint in claims data. Interestingly, undergoing a procedure in pregnancy was associated with a reduced risk of NPOU: this may be because surgical management provided definitive treatment of patients’ pain (eg, performing a cholecystectomy for a patient with cholelithiasis or the surgical management of nephrolithiasis), or the pain related to nonsurgical diagnoses conferred unique risks of NPOU. A more granular understanding of the diagnoses associated with opioid prescribing will be crucial for setting best practices for pain management.
Strengths and limitations
Our study has several important limitations. First, the generalizability of our study is limited by our requirement for 3 years of continuous insurance enrollment; this was necessary to clearly define the impact of opioid prescribing in pregnancy, but likely underestimates rates of NPOU. In addition, we assessed pharmacy claims for women with commercial insurance, limiting the generalizability of our findings. As approximately one-half of all births in the United States are covered by private insurance, these results are applicable to a wide group. Second, the number of eligible births in our cohort decreased between 2008 and 2016. Although decreased fertility rates may account for a portion of this reduction, it does not fully explain the 40% decline. It is possible that fewer women in 2016 were opioid naive entering pregnancy, or that continuous enrollment for our prespecified period is less common in 2016 compared to prior years. Future analyses will investigate these findings in broader cohorts. Finally, using pharmacy claims allows us to identify only those prescriptions that were filled. We cannot identify whether prescriptions were written but not filled, prescriptions were filled but not all opioid pills consumed, or opioids were consumed that were not prescribed. Future work including direct patient inquiry will be helpful for elucidating these differences.
Still, we believe that these limitations are outweighed by our study’s strengths. These include the novel evaluation of pregnancy opioid exposure as a risk factor for NPOU, the large sample size, and the longitudinal assessment of risk across pregnancy up to 1 year postpartum. This work fills an important knowledge gap about the long-term effects of opioid prescribing during pregnancy, and represents the best currently available data.
Conclusion
Many women receive opioid prescriptions during pregnancy, of whom, 1 in 25 develop new persistent opioid use after childbirth. Future work is needed to clarify the safety of opioid alternatives, to define prescribing guidelines in pregnancy, and to implement opioid-sparing regimens not just at the time of delivery but also throughout pregnancy.
References
Wilson R.D.
Caughey A.B.
Wood S.L.
et al.
Guidelines for antenatal and preoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 1).
Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice.
Prenatal risk factors and perinatal and postnatal outcomes associated with maternal opioid exposure in an urban, low-income, multiethnic US population.
Association of cord plasma biomarkers of in utero acetaminophen exposure with risk of attention-deficit/hyperactivity disorder and autism spectrum disorder in childhood.
VKD is a contributing editor for the Medical Letter and an author for Up-to-Date. She is also a consultant for Bind. CFB is a consultant for Heron Therapeutics (San Diego, CA). All other authors report no conflict of interest.
Financial support for research was provided by the National Institute on Drug Abuse (R01DA042859) (CFB, JFW). This work is supported by a grant from the Michigan Department of Health and Human Services, Blue Cross Blue Shield of Michigan, and SAMSHA. Grant funding was also provided by the Agency on Health Care Quality and Research, American Association of Obstetricians and Gynecologists Foundation, the Laura and John Arnold Foundation, National Institute for Reproductive Health, Blue Cross Blue Shield Foundation and the National Institutes for Health (VKD).
Cite this article as: Peahl AF, Morgan DM, Dalton VK, et al. New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis. Am J Obstet Gynecol 2020;223:566.e1-13.
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