Birth outcomes with prescribed chronic and acute opioid exposure during pregnancy

Abstract

Objectives: To assess the effects of no, any, and acute and chronic prescription opioid exposure for pain during pregnancy on maternal and fetal outcomes.Design: Retrospective cohort study.Setting: Integrated healthcare delivery system. Information on pregnancies and their outcomes were obtained from administrative data and verified via manual chart review.Participants: Women ≥ 18 years of age who were pregnant between January 1, 2012 and May 31, 2015 and had chronic, acute, and no opioid exposure; defined as an ambulatory dispensing(s) of 30 (with a total of 225 morphine equivalents), 1-29, and 0 days supply of opioid, respectively, during pregnancy.Main outcome measure: Non-live birth.Results: A total 13,809 pregnancies for 13,131 women were included. Pregnancies with opioid exposure had higher risk scores and more comorbid conditions. A total of 1,319 (9.6 percent) pregnancies had any documented opioid exposure during pregnancy with 125 (1.0 percent) and 1,194 (8.7 percent) pregnancies having had chronic and acute opioid exposure, respectively. Pregnancies with acute opioid exposure had a higher percentage of non-live births (3.1 percent) compared to pregnancies (1.0 percent) with no opioid exposure (adjusted odds ratio = 3.46, 95% confidence interval 2.33-5.14) but no difference compared to pregnancies with chronic (1.6 percent) opioid exposure (p 0.05 with adjustment).Conclusions: While a dose response of opioid exposure was not identified, these results add to existing evidence that opioid exposure during pregnancy is correlated with negative outcomes. Practitioners may better serve pregnant women and their fetuses by encouraging alternate pain relief treatments.

Association of Gestational Opioid Exposure and Risk of Major and Minor Congenital Malformations

“…7 Other studies suggested that gestational opioid exposure is associated with the risk of congenital malformations. [8][9][10] Thus, whether opioid use in pregnancy is associated with major congenital malformations remains unclear. The goal of this study was to evaluate the risk of congenital malformations associated with gestational prescription opioid exposure among pregnant women enrolled in the Rhode Island state Medicaid program.…”

“…Two recent large cohort studies reported that prenatal opioid exposure in the first trimester is not associated with a higher risk of major congenital malformations, but codeine use during early pregnancy was associated with a higher risk of spina bifida . Other studies suggested that gestational opioid exposure is associated with the risk of congenital malformations . Thus, whether opioid use in pregnancy is associated with major congenital malformations remains unclear.…”