Various risk factors tied to opioid overdose for pregnant, postpartum women

Key takeaways:

• Medication for opioid use disorder was tied to reducing opioid overdose during pregnancy and postpartum.
• Opioid overdose risk factors included homelessness, incarceration, younger age, unmarried status and more.

SAN FRANCISCO — Socioeconomic and sociodemographic factors are associated with opioid overdose in pregnant and postpartum women, highlighting the need for more research, drug screening and judgment-free services for those at high risk.

“In Florida, opioid overdoses are the No. 1 cause of death in pregnancy and postpartum individuals,” Kelly A. Campbell, BS, an MD candidate at Morsani College of Medicine at the University of South Florida, said during a presentation at the ACOG Annual Clinical & Scientific Meeting. “With our scoping review, we're hoping to summarize the literature out there describing the risk factors for these patients that may predispose them to have an overdose event.”

Campbell and colleagues conducted a scoping review using PubMed, CINAHL, Embase, Web of Science, Scopus, ClinicalTrials.gov and PsycINFO to identify eight studies that assessed pregnant and/or postpartum women with opioid use disorder and differentiated data between those who experienced opioid overdose and those who did not.

Overall, 90,860 pregnant or postpartum women with opioid use disorder were included in the eight studies.

One study observed a decrease of 2% for adjusted OR for overdose with each additional week of medication. In another study, researchers looked at supportive and punitive substance use policies in different states. Supportive policies were more likely to offer medication for opioid use disorder and ancillary services such as childcare, domestic violence assistance and employment. Supportive policies were associated with an 11% increase in medication for opioid use disorder and punitive policies with a 45% increase in opioid overdose.

In addition, seven studies assessed social determinants of health and noted the following as risk factors for opioid overdose:

• homelessness;
• incarceration;
• younger age;
• unmarried status;
• postpartum status;
• public insurance; and
• not graduating high school.

Regarding comorbidities, studies observed a higher likelihood of opioid overdose for women with pregnancy complications, concurrent substance use disorders and, possibly, mental health disorders.

The most frequently identified factor reducing the risk for opioid overdose was the consistent use of medication for opioid use disorder during pregnancy and postpartum. Researchers observed inconsistent information on the effect of race and concurrent psychiatric disorders on opioid overdose.

“Our study findings are consistent with endorsing the consistent use of medications for opioid use disorder throughout the pregnancy and postpartum period,” Campbell said. “It advises to be mindful of those with certain comorbidities, social determinants of health and timing during pregnancy — all that can make patients more vulnerable.”