Use of opioids during pregnancy and effects of pregnancy outcomes

Abstract

Purpose To evaluate the use of opioids in pregnant primiparous women and study the effect of opioid use on maternal and offspring delivery outcomes. Methods The study cohort (N = 6231) consists of all primiparous women with a Finnish background who delivered a singleton between 2009 and 2015 in the city of Vantaa, Finland. Data on births, maternal characteristics, pregnancy outcomes, and purchases of prescription drugs were obtained from National Health Registers. Results Of the primiparous women, 5.1% used opioids during pregnancy. Of these, 95.9% used codeine. No differences were observed in purchases of opioids between the different trimesters but more women purchased opioids as pregnancy progressed (.002). Users of opioids more often also purchased other prescription drugs compared with non‐users of opioids, 89% versus 58% (P < .001); age, smoking, education, and body mass index adjusted odds ratio 5.66 (95% confidence interval 3.96 to 8.09). Caesarean sections were more common in users of opioids than in non‐users, 28.3% versus 21.9% (.007). Before the age of 7 days, the offspring of users of opioids more often needed respirator treatment compared with the offspring of non‐users, 3.1% versus 1.6% (.044). Conclusions One out of 20 pregnant women used opioids. Use of opioids during pregnancy was associated with the risk for deliveries by caesarean sections and need for respiratory treatment among the offspring during the first week of life. Further safety evaluations are needed.

Maternal opioids age-dependently impair neonatal respiratory control networks

“…Maternal opioids cross the placenta ( Nanovskaya et al, 2008 ), directly disrupting in utero fetal development (including neural tube formation; Williams et al, 1991 ), with the most severe effects occurring late in gestation when opioids accumulate in the fetus ( Conradt et al, 2018 ). Infants born after in utero opioid exposure are often diagnosed with Neonatal Abstinence Syndrome (NAS), which presents as a diverse set of symptoms, including sleep disturbances, temperature instability, tremors, seizures, high pitched crying, excessive yawning, tachypnea ( McQueen and Murphy-Oikonen, 2016 ), apneas, and respiratory deficits ( Fältmarch et al, 2019 ). Although these symptoms are thought to result from dysfunctions in the central and autonomic nervous systems, and gastrointestinal system, their etiology remains poorly understood ( McQueen and Murphy-Oikonen, 2016 ).…”

Prevalence and duration of prescribed opioid use during pregnancy: a cohort study from the Quebec Pregnancy Cohort

“…Pain during pregnancy is common as low back pain and pelvic pain may occur in over 70% of pregnancies [1,2]. Opioids reduce the intensity of pain signal perception and over the past 20 years, the prevalence of prescribed opioids use during pregnancy has increased considerably [3][4][5][6][7][8][9][10][11][12][13].…”

Prescription opioid use in Australian women of reproductive age: Implications for unplanned pregnancies

“…Opioids readily cross placental and blood–brain barriers, and maternal use of opioids can act directly on the foetus 17,18 . The short‐ and long‐term consequences of in utero opioid exposure on maternal and foetal health and development remain ill‐defined due to the systematic exclusion of pregnant women from clinical trials 19 .…”

“…The short‐ and long‐term consequences of in utero opioid exposure on maternal and foetal health and development remain ill‐defined due to the systematic exclusion of pregnant women from clinical trials 19 . While postmarket observational studies have linked opioid use during pregnancy with congenital malformations in infants 15,16,20–26 and adverse obstetric 17,23,27,28 and neonatal outcomes, 17,23,29–32 uncertainty remains as to whether these associations represent causal relationships.…”

“…Observational studies have reported associations between first trimester prescription opioid exposure and congenital malformations in infants such as oral clefts 15,16,20–26 . Adverse perinatal outcomes such as placenta‐mediated pregnancy complications and neonates born small for gestational age 15,17,23,27,29,32 have been observed following use of prescription opioids anytime during pregnancy. While the existing research has largely focused on assessing opioids as a class, there is some evidence to suggest that individual opioids, such as codeine (alone or in combination), oxycodone and tramadol, confer specific risks of harm 15,22,23,33,34 …”