Birth outcomes with prescribed chronic and acute opioid exposure during pregnancy

Thomas Delate, PhD, MS; Megan Hodges, PharmD; Morgan Swank, MD; Taylor Ota, PharmD Candidate; Christy L. Pratt, PharmD

doi:10.5055/jom.2019.0529

Authors

Thomas Delate, PhD, MS
Megan Hodges, PharmD
Morgan Swank, MD
Taylor Ota, PharmD Candidate
Christy L. Pratt, PharmD

DOI:

https://doi.org/10.5055/jom.2019.0529

Keywords:

opioid analgesics, pregnancy, maternal-fetal exchange, pregnancy outcome, integrated healthcare systems

Abstract

Objectives: To assess the effects of no, any, and acute and chronic prescription opioid exposure for pain during pregnancy on maternal and fetal outcomes.

Design: Retrospective cohort study.

Setting: Integrated healthcare delivery system. Information on pregnancies and their outcomes were obtained from administrative data and verified via manual chart review.

Participants: Women ≥ 18 years of age who were pregnant between January 1, 2012 and May 31, 2015 and had chronic, acute, and no opioid exposure; defined as an ambulatory dispensing(s) of > 30 (with a total of 225 morphine equivalents), 1-29, and 0 days supply of opioid, respectively, during pregnancy.

Main outcome measure: Non-live birth.

Results: A total 13,809 pregnancies for 13,131 women were included. Pregnancies with opioid exposure had higher risk scores and more comorbid conditions. A total of 1,319 (9.6 percent) pregnancies had any documented opioid exposure during pregnancy with 125 (1.0 percent) and 1,194 (8.7 percent) pregnancies having had chronic and acute opioid exposure, respectively. Pregnancies with acute opioid exposure had a higher percentage of non-live births (3.1 percent) compared to pregnancies (1.0 percent) with no opioid exposure (adjusted odds ratio = 3.46, 95% confidence interval 2.33-5.14) but no difference compared to pregnancies with chronic (1.6 percent) opioid exposure (p > 0.05 with adjustment).

Conclusions: While a dose response of opioid exposure was not identified, these results add to existing evidence that opioid exposure during pregnancy is correlated with negative outcomes. Practitioners may better serve pregnant women and their fetuses by encouraging alternate pain relief treatments.

Author Biographies

Thomas Delate, PhD, MS

Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado

Megan Hodges, PharmD

Clinical Pharmacy Department, Yakima Heart Center, Yakima, Washington

Morgan Swank, MD

Department of Maternal Fetal Medicine, Kaiser Permanente Colorado, Denver, Colorado

Taylor Ota, PharmD Candidate

Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado; Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado

Christy L. Pratt, PharmD

Pharmacy Department, Kaiser Permanente Colorado, Aurora, Colorado

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