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Exposure to prescription opioid analgesics in-utero and the risk of neonatal abstinence syndrome: A population-based cohort study
Abstract Number: S-08
Abstract Type: Original Research
Background: The use of prescription opioids for treating pain in pregnancy is common and increasing. While the risk of neonatal abstinence syndrome (NAS) in the offspring of women who either illicitly use opioids or who are on opioid maintenance therapy is well recognized, the risks associated with prescription opioid use are less well characterized.
Methods: Data were derived from the Medicaid Analytic Extract (MAX) which contains information on Medicaid beneficiaries from 46 states. We defined a cohort of women who filled at least one outpatient prescription for an opioid analgesic at any time during pregnancy. Opioid exposure characteristics including duration of therapy (short-term (<30 day supply) or long-term (≥ 30 day supply)), and timing of use (early use (only in the first two trimesters) or late use (extending into the third trimester)) were assessed. The primary outcome was a diagnosis of NAS among the live-born infants of these women.
Results: A total of 1,705 cases of NAS were identified among the infants of 290,605 pregnant women filling opioid prescriptions. Long-term opioid use during pregnancy resulted in higher risk of NAS (reported per 1000 deliveries (95% confidence interval)) in the presence of additional risk factors of known opioid abuse (220.2 (200.8 to 241.0)), alcohol or other drug abuse (30.8 (26.1 to 36.0)), exposure to other psychotropic medications (13.1 (10.6 to 16.1)), and smoking (6.6 (4.3 to 9.6)) than in the absence of any of these risk factors (4.2 (3.3 to 5.4)). The corresponding risk estimates for short-term use were 192.0 (175.8 to 209.3), 7.0 (6.0 to 8.2), 2.0 (1.5 to 2.6), and 1.5 (1.0 to 2.0) per 1000 deliveries, respectively; the risk associated with short-term use in the absence of additional risk factors was 0.7 (0.6 to 0.8). Late use of prescription opioids in pregnancy generally resulted in higher NAS risk compared with early use.
Conclusion: This large, population-based cohort study indicates that short-term use of prescription opioids for treating acute pain during pregnancy is associated with a very low risk of NAS in the absence of other additional risk factors.