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The Opioid Dependent Parturient - Is She Different?
Abstract Number: F3C-203
Abstract Type: Original Research
Maternal opioid use complicates 5.6 per 1,000 hospital births per year, with associated risks of later prenatal care, IUGR, and neonatal abstinence syndrome (NAS).[i] Opioid tolerance, nicotine use, and cormorbid psychiatric conditions further complicate postpartum pain management.[ii] An optimal care pathway for these women has not yet been identified. The purpose of this study was to examine care needs and patterns in mothers on opioids compared to the general population. We hypothesized that women with chronic opioid use would have increased psychiatric diagnoses, higher pain scores throughout the peripartum period, and greater inconsistency in discharge opioid prescriptions compared with controls. The results of this study will be used to guide the development of a care plan to optimize maternal outcomes and minimize risk of relapse postpartum.
A case-control, retrospective chart review was conducted at our high risk women’s center (~ 6,000 deliveries/yr) looking at deliveries between Jan 1 2016 – Aug 9 2017. Patients were identified by reviewing charts of mothers whose infants who were admitted to the NICU for neonatal abstinence syndrome (NAS, n=194) and compared to women who delivered during the same time period whose infants were not admitted to the NICU for NAS (Non-NAS,N=194). Comparisons were made using independent t-tests (demographics), negative binomial test (ED visits) and Fisher’s Exact test (opioid use and pain scores).
Women in the NAS group had significantly lower BMIs (p<.0001), were more likely to smoke (p<.0001), and had more co-existing psychiatric diagnoses (p<.0001). There were no significant differences in mode of delivery, type of labor analgesia, or IV opioid use during labor. Women in the NAS group had significantly higher pain scores on admission to the labor floor (4.8 vs 3.7, p<.006), arrival to postpartum (4.0 vs. 2.2, p<.0001), and at discharge from the PACU (5.3 vs 2.9, p<.001). Interestingly, 39(20%) women in the NAS group were discharged with no new opioid prescription, while others in the group received a new Rx for one of seven different opioids of varying strength and quantity. None of the patients in the control group were sent out without a new opioid prescription (n=0). The NAS group had significantly more ED visits at our hospital within 6 mos of delivery than the non-NAS group (p=0.0044).
This chart review highlights the need for continued research on the optimal care pathway for patients using opioids during pregnancy. While reducing intrapartum and postpartum pain scores is an important goal, more pressing initiatives may include the incidence of overdose, relapse, and hospitalization after delivery. A multidisciplinary approach to pre and post-natal care, consistency in discharge opioids, and close follow up after delivery should likely be a part of future care pathways for this patient population.
[i] Womenshealth.gov white paper
[ii] Pan and Zakowsi