Opioid Abuse and Dependence during Pregnancy: Epidemiology, Temporal Trends, Risk Factors and Associated Maternal and Obstetrical Outcomes

Abstract Number: GM-04
Abstract Type: Original Research

Background: This study sought to (1) investigate the nationwide trends in maternal opioid abuse/dependence during pregnancy in the United States (U.S.), and (2) assess its impact on maternal and obstetrical outcomes.

Methods: Hospitalizations for delivery were extracted from the Nationwide Inpatient Sample, which contains information on approximately 20% of all delivery admissions in the U.S. Using ICD-9 CM diagnosis codes, we identified deliveries, maternal opioid abuse/dependence and obstetrical outcomes that may be associated with maternal opioid abuse/dependence. Temporal trends in the prevalence of maternal opioid abuse/dependence from 1998 to 2011 were assessed. With data from 2007 to 2011, logistic regression analysis was used to examine the associations between maternal opioid abuse/dependence and obstetrical outcomes, controlling for maternal age, race, insurance type, tobacco, alcohol, or other illicit drug use, and psychiatric conditions. We conducted a sensitivity analysis comparing obstetrical outcomes in women with opioid abuse/dependence and those abusing/dependent on other illicit drugs in an effort to overcome the confounding effects of lifestyle, nutrition, and other factors that are difficult to account for in administrative data.

Results: The prevalence of opioid abuse/dependence during pregnancy increased by 127% during the study period (from 1.7 per 1,000 deliveries in 1998 to 3.9 per 1,000 deliveries in 2011) (p for trend <0.001). Trends analysis stratified by age and race revealed the most dramatic increases among the age group 20-34 years (162%), and white women (479%), respectively. Maternal opioid abuse/dependence was associated with an increased risk of obstetrical complications, including maternal death during hospitalization (adjusted odds ratio (aOR) 4.63, 95% confidence interval (CI) 1.77-12.12), maternal cardiac arrest (aOR 3.60, 95% CI 1.42-9.12), length of stay >7 days (aOR 2.2, 95% CI 1.97-2.50), transfusion (aOR 1.70, 95% CI 1.49-1.93), caesarean delivery (aOR 1.20, 95% CI 1.12-1.27), placental abruption (aOR 2.35, 95% CI 2.14-2.58), premature rupture of membrane (PROM) (aOR 1.44, 95% CI 1.32-1.58), stillbirth (aOR 1.53, 95% CI 1.28-1.82), preterm labor (aOR 2.13, 95% CI 1.99-2.27), intrauterine growth restriction (aOR 2.66, 95% CI 2.42-2.93), and oligohydramnios (aOR 1.72, 95% CI 1.57-1.88). When we compared opioid and non-opioid drug abusing/dependent parturients, all the statistically significant associations from the primary analysis persisted except for maternal cardiac arrest, placental abruption and PROM.

Conclusion: Opioid abuse/dependence during pregnancy is associated with considerable obstetrical morbidity and maternal mortality, and its prevalence is dramatically increasing in the U.S. Given the epidemic of opioid abuse in the U.S., identifying preventive strategies and therapeutic interventions in women who continue to abuse opioids during pregnancy are important priorities for future research.

SOAP 2014