Opioid increases odds of maternal mortality and obstetric morbidity

Opioid abuse and dependency during pregnancy is rising, especially among women aged 20 to 34 years, according to a recent study.

“Overdose deaths from opioid pain relievers in women of all ages have increased five-fold between 1999 and 2010 and are continuing to rise. Recent work suggests that opioids are commonly prescribed during pregnancy,” the researchers wrote.

Researchers collected data on hospitalizations for delivery from the National Inpatient Sample of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. The researchers studied 113,105 women hospitalized for delivery who they recognized as abusing or dependent on opioids between 1998 and 2011.

Opioid abuse or dependence during pregnancy increased from 0.17% in 1998 to 0.39% in 2011, an increase of 127%. The most significant increase in opioid abuse or dependency occurred in women aged 20 to 34 years (162%; 1.8 admissions per 1,000 deliveries in 1998 to 4.5 per 1,000 deliveries in 2011).

Pregnant women abusing or dependent on opioids had increased odds of major obstetrical mortality or morbidity (aOR,=4.6; 95% CI, 1.8-12.1). Those on opioids while pregnant also had an increased likelihood of cardiac arrest (aOR=3.6; 95% CI, 1.4-9.1), intrauterine growth restriction, (aOR=2.7; 95% CI, 2.4-2.9, placental abruption (aOR=2.4; 95% CI, 2.1-2.6) length of stay more than 7 days (aOR=2.2; 95% CI, 2-2.5), preterm labor (aOR=2.1; 95% CI, 2-2.3), oligohydramnios (aOR=1.7; 95% CI, 1.6-1.9), transfusion (aOR=1.7; 95% CI, 1.5-1.9), stillbirth (aOR=1.5; 95% CI, 1.3-1.8), premature rupture of membranes (aOR=1.4; 95% CI, 1.3-1.6), and cesarean delivery (aOR=1.2; 95% CI, 1.1-1.3), according to researchers.

“The most frequently prescribed opioids among women in both groups were hydrocodone, codeine and oxycodone. Efforts are needed to promote interventions to reduce opioid prescriptions among this population to reduce opioid prescriptions among this population when safer alternative treatments are available,” Elizabeth C. Ailes, PhD, of the division of birth defects and developmental disabilities at the CDC, and colleagues wrote in the Morbidity and Mortality Weekly Report.

For more information:

Maeda A. Anesthesiology. 2014;doi:10.1097/ALN.0000000000000472.

CDC. Morbidity and Mortality Weekly Report. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6402a1.htm?s_cid=mm6402a1_w. Accessed January 25, 2015.

Disclosure: The researchers report no relevant financial disclosures.