Opioid abuse in pregnant women on rise

Prevalence of opioid abuse during pregnancy has more than doubled over the past 14 years, according to a new study in Anesthesiology.  Narcotic dependence, the researchers found, was associated with a 4.6-fold increased risk of maternal death during hospitalization.

Presented at the Society for Obstetric Anesthesia and Perinatology Annual Meeting, the findings were based on data from the Nationwide Inpatient Sample, which included nearly 57 million women admitted to U.S. hospitals for delivery between 1998 and 2011. Researchers examined associations between maternal opioid abuse or dependence and obstetrical outcomes, using logistic regression and adjusting for confounders.

During the study period, the prevalence of opioid abuse or dependence increased from 0.17% to 0.39%, an increase of 127%. When compared with deliveries with no maternal opioid abuse or dependence, deliveries to mothers with opioid abuse or dependence were associated with increased odds of maternal death during hospitalization (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.8 to 12.1, crude incidence 0.03 vs 0.006%), cardiac arrest (aOR, 3.6; 95% CI, 1.4 to 9.1; 0.04 vs 0.01%), placental abruption (aOR, 2.4; 95% CI, 2.1 to 2.6; 3.8 vs 1.1%), length of stay more than 7 days (aOR, 2.2; 95% CI, 2.0 to 2.5; 3.0 vs 1.2%), oligohydramnios (aOR, 1.7; 95% CI, 1.6 to 1.9; 4.5 vs 2.8%), and transfusion (aOR, 1.7; 95% CI, 1.5 to 1.9; 2.0 vs 1.0%).  

Additional outcomes negatively impacted by narcotic dependence included stillbirth (aOR, 1.5; 95% CI, 1.3 to 1.8; 1.2 vs 0.6%), intrauterine growth restriction (aOR, 2.7; 95% CI, 2.4 to 2.9; 6.8 vs 2.1%), premature rupture of membranes (aOR, 1.4; 95% CI, 1.3 to 1.6; 5.7 vs 3.8%), preterm labor (aOR, 2.1; 95% CI, 2.0 to 2.3; 17.3 vs 7.4%), and cesarean delivery (aOR, 1.2; 95% CI, 1.1 to 1.3; 36.3 vs 33.1%).

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Despite the large sample size, the researchers were unable to confirm the diagnoses and comorbidities with a chart review because patient data were deidentified. Information on other covariates such as maternal weight, body mass index, and gestational age also were unavailable. It also was not possible to differentiate between women who abused or were dependent on opioid drugs; women who were enrolled in opioid maintenance programs; or those who abused heroin.

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