Prescription opioid use during pregnancy and risk for preterm birth or term low birthweight

Julia D. Interrante, MPH; Stacey L. P. Scroggs, PhD; Carol J. Hogue, PhD; Jan M. Friedman, MD; Jennita Reefhuis, PhD; Michael W. Jann, PharmD; Cheryl S. Broussard, PhD; National Birth Defects Prevention Study

doi:10.5055/jom.2021.0632

Authors

Julia D. Interrante, MPH
Stacey L. P. Scroggs, PhD
Carol J. Hogue, PhD
Jan M. Friedman, MD
Jennita Reefhuis, PhD
Michael W. Jann, PharmD
Cheryl S. Broussard, PhD https://orcid.org/0000-0001-6428-8523
National Birth Defects Prevention Study

DOI:

https://doi.org/10.5055/jom.2021.0632

Keywords:

analgesics, opioid, infant, low birthweight, pregnancy, premature birth

Abstract

Objective: Examine the relationship between prescription opioid analgesic use during pregnancy and preterm birth or term low birthweight.

Design, setting, and participants: We analyzed data from the National Birth Defects Prevention Study, a US multisite, population-based study, for births from 1997 to 2011. We defined exposure as self-reported prescription opioid use between one month before conception and the end of pregnancy, and we dichotomized opioid use duration by ≤7 days and >7 days.

Main outcome measures: We examined the association between opioid use and preterm birth (defined as gestational age <37 weeks) and term low birthweight (defined as <2500 g at gestational age ≥37 weeks).

Results: Among 10,491 singleton mother/infant pairs, 470 (4.5 percent) reported opioid use. Among women reporting opioid use, 236 (50 percent) used opioids for > 7 days; codeine (170, 36 percent) and hydrocodone (163, 35 percent) were the most commonly reported opioids. Opioid use was associated with slightly increased risk for preterm birth [adjusted odds ratio, 1.4; 95 percent confidence interval, 1.0, 1.9], particularly with hydrocodone [1.6; 1.0, 2.6], meperidine [2.5; 1.2, 5.2], or morphine [3.0; 1.5, 6.1] use for any duration; however, opioid use was not significantly associated with term low birthweight.

Conclusions: Preterm birth occurred more frequently among infants of women reporting prescription opioid use during pregnancy. However, we could not determine if these risks relate to the drug or to indications for use. Patients who use opioids during pregnancy should be counseled by their practitioners about this and other potential risks associated with opioid use in pregnancy.

Author Biographies

Julia D. Interrante, MPH

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee

Stacey L. P. Scroggs, PhD

New Mexico State University, Las Cruces, New Mexico

Carol J. Hogue, PhD

Rollins School of Public Health, Emory University, Atlanta, Georgia

Jan M. Friedman, MD

Department of Medical Genetics and Genomics, University of British Columbia, Vancouver, British Columbia, Canada

Jennita Reefhuis, PhD

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia

Michael W. Jann, PharmD

University of North Texas Health Science Center, Fort Worth, Texas

Cheryl S. Broussard, PhD

National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia

References

ACPA resource guide to pain medication and treatments. American Chronic Pain Association, 2019. Available at https://www.theacpa.org/wp-content/uploads/2019/02/ACPA_Resource_Guide_2019.pdf. Accessed February 16, 2021.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65: 1-49.

Dowell D, Haegerich T, Chou R: No shortcuts to safer opioid prescribing. N Engl J Med. 2019; 380: 2285-2287.

Bohnert ASB, Guy GP Jr, Losby JL: Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention’s 2016 opioid guideline. Ann Intern Med. 2018; 169: 367-375.

National Center for Injury Prevention and Control: Opioid overdose: US prescribing rate maps. Centers for Disease Control and Prevention, 2017. Available at https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html. Accessed February 16, 2021.

Manchikanti L, Singh A: Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008; 11: S63-S88.

Joranso DE, Ryan KM, Gilson AM: Trends in medical use and abuse of opioid analgesics. JAMA. 2000; 283: 1710-1714.

National Center for Health Statistics: Health, United States, 2006. Hyattsvile, MD: Department of Health and Human Services, 2007.

Kellogg A, Rose CH, Harms RH: Current trends in narcotic use in pregnancy and neonatal outcomes. Am J Obstetr Gynecol. 2011; 204: 259.e1-259.e4.

Ailes EC, Dawson AL, Lind JN, et al.: Opioid prescription claims among women of reproductive age—United States, 2008-2012. MMWR. 2015; 64: 37-41.

Creanga AA, Sabel JC, Ko JY, et al.: Maternal drug use and its effect on neonates: A population-based study in Washington State. Obstetr Gynecol. 2012; 119: 924-933.

Bateman BT, Hernandez-Diaz S, Rathmell JP, et al.: Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States. Anesthesiology. 2014; 120: 1216-1224.

Desai RJ, Hernandez-Diaz S, Bateman BT, et al.: Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstetr Gynecol. 2014; 123: 997-1002.

Patrick SW, Dudley J, Martin PR, et al.: Prescription opioid epidemic and infant outcomes. Pediatrics. 2015; 135: 842-850.

Desai RJ, Huybrechts KF, Hernandez-Diaz S, et al.: Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study. BMJ. 2015; 350: h2102.

Broussard CS, Rasmussen SA, Reefhuis J, et al.: Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstetr Gynecol. 2011; 204: 314.e1-314.e11.

Yazdy MM, Mitchell AA, Tinker SC, et al.: Periconceptional use of opioids and the risk of neural tube defects. Obstetr Gynecol. 2013; 122: 838-844.

Wilbourne P, Wallerstedt C, Dorato V, et al.: Clinical management of methadone dependence during pregnancy. J Perinatal Neonatal Nurs. 2001; 14: 26-45.

Sujan AC, Quinn PD, Rickert ME, et al.: Maternal prescribed opioid analgesic use during pregnancy and associations with adverse birth outcomes: A population-based study. PLoS Med. 2019; 16(12): e1002980.

Reddy UM, Davis JM, Ren Z, et al.: Opioid use in pregnancy, neonatal abstinence syndrome, and childhood outcomes: Executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol. 2017; 130(1):10-28.

Yazdy MM, Desai RJ, Brogly SB: Prescription opioids in pregnancy and birth outcomes: A review of the literature. J Pediatr Genet. 2015; 4: 56-70.

Martin JA, Hamilton BE, Osterman MJK, et al.: Births: Final data for 2017. Natl Vital Stat Rep. 2018; 67(8): 1-50.

Martin JA, Kirmeyer S, Osterman M, et al.: Born a bit too early: Recent trends in late preterm births. NCHS Data Brief, No. 24. Hyattsville, MD: National Center for Health Statistics, 2009: 1-8.

Mathews TJ, MacDorman MF: Infant mortality statistics from the 2007 period linked birth/infant death data set. Natl Vital Stat Rep. 2011; 59: 1-30.

Arnon S, Dolfin T, Litmanovitz I, et al.: Preterm labour at 34–36 weeks of gestation: Should it be arrested? Paediatr Perinatal Epidemiol. 2001;15: 252-256.

Ramachandrappa A, Jain L: Health issues of the late preterm infant. Pediatr Clin North Am. 2009; 56: 565-577.

Wilcox AJ: Outcomes. In: Fertility and Pregnancy: An Epidemiologic Perspective. New York: Oxford University Press, 2010: 123-229.

Yoon PW, Rasmussen SA, Lynberg MC, et al.: The National Birth Defects Prevention Study. Public Health Rep. 2001; 116: 32-40.

Reefhuis J, Gilboa SM, Anderka M, et al.: The National Birth Defects Prevention Study: A review of the methods. Birth Defects Res Part A. 2015; 103: 656-669.

Interrante JD, Ailes EC, Lind JN, et al.: Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997-2011. Ann Epidemiol. 2017; 27(10): 645-653.e2.

Kelley K, Kelly T, Kaufman D, et al.: The Slone drug dictionary: A research-driven pharmacoepidemiology tool. Pharmacoepidemiol Drug Saf. 2003; 12: S168-S169.

Kramer MS: The epidemiology of adverse pregnancy outcomes: An overview. J Nutr. 2003; 133(5): 1592S-1596S.

Goldenberg RL, Culhane JF, Iams JD: Epidemiology and causes of preterm birth. Lancet. 2008; 371(9606): 75-84.

Shapiro-Mendoza CK, Lackritz EM: Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med. 2012; 17(3): 120-125.

Hamilton BE, Martin JA, Osterman MJ, et al.: Births: Final data for 2014. Natl Vital Stat Rep. 2015; 64: 1-64.

Källén B, Borg N, Reis M: The use of central nervous system active drugs during pregnancy. Pharmaceuticals. 2013; 6: 1221-1286.

Nørgaard M, Nielsson MS, Heide-Jørgensen U: Birth and neonatal outcomes following opioid use in pregnancy: A Danish population-based study. Subst Abuse: Res Treat. 2015; 9: 5-11.

Cleary BJ, Donnelly JM, Strawbridge JD, et al.: Methadone and perinatal outcomes: A retrospective cohort study. Am J Obstetr Gynecol. 2011; 204: 139.e1-139.e9.

Greig E, Ash A, Douiri A: Maternal and neonatal outcomes following methadone substitution during pregnancy. Arch Gynecol Obstetr. 2012; 286: 843-851.

Sharpe C, Kuschel C: Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Disease Childhood. 2004; 89: F33-F36.

Nezvalová-Henriksen K, Spigset O, Nordeng H: Effects of codeine on pregnancy outcome: Results from a large population-based cohort study. Eur J Clin Pharmacol. 67: 1253-1261.

Smith MV, Costello D, Yonkers KA: Clinical correlates of prescription opioid analgesic use in pregnancy. Matern Child Health J. 2015; 19(3): 548-556.

Cogswell ME, Bitsko RH, Anderka M, et al.: Control selection and participation in an ongoing, population-based, case-control study of birth defects: the National Birth Defects Prevention Study. Am J Epidemiol. 2009; 170: 975-985.

Moutquin JM: Classification and heterogeneity of preterm birth. Br J Obstetr Gynaecol. 2003; 110 Suppl 20: 30-33.