About 1 in 5 pregnant women in US misused prescription opioids, over 30% not warned of its effects: CDC
An estimated one in five women reported that they have misused prescription opioids during pregnancy, according to an analysis by the US Centers for Disease Control and Prevention (CDC). Opioids are a class of drugs used to reduce pain. The researchers also found that more than one in four (27.1%) women with prescription opioid use indicated wanting or needing to reduce or stop their use, potentially because of concerns about the effect of medication on their infant, possible opioid dependence, or opioid use disorder. Among women reporting prescription opioid use, nearly one in three (31.9%) reported not receiving provider counseling on the effects of prescription opioid use on an infant, shows analysis.
During 2017-18, 42.5% of opioid-related overdose deaths among women in the US involved a prescription opioid. The agency says that prescription opioid use during pregnancy has been associated with poor outcomes for mothers and infants. Studies using administrative data have estimated that 14-22% of women filled a prescription for opioids during pregnancy, but data on self-reported prescription opioid use during pregnancy are limited. Accordingly, the CDC analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey in 32 jurisdictions and maternal and infant health surveys in two additional jurisdictions not participating in PRAMS. The objective was to estimate self-reported prescription opioid use during pregnancy overall and by maternal characteristics among women with a recent live birth. Experts from the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and the National Center for Injury Prevention and Control were involved in the study.
The analysis shows that in 2019, among 21,488 respondents, 20,643 (96.1%) provided information regarding prescription opioid use during their most recent pregnancy. Among these women, 1,405 (6.6% or one in 15) reported prescription opioid use during pregnancy. “In this study, an estimated one in five women using prescription opioids during pregnancy indicated misuse. Overall, 21.2% of women who used prescription opioids during pregnancy reported misuse (a source other than a healthcare provider or a reason for use other than pain); 4% reported both a non-healthcare provider source and use for reasons other than pain,” the authors write.
Of those who used prescription opioids during pregnancy, 27.1% indicated wanting or needing to cut down or stop using. “Among women who used prescription opioids during pregnancy, a higher proportion of women with misuse (36.5%) indicated wanting or needing to cut down or stop using, compared with women without misuse (24.5%),” says the team.
The researchers found that among women who used prescription opioids, 91.3% reported receiving the opioids from a healthcare provider, 8.9% from a source other than a healthcare provider (such as a friend or family member), and 4.3% from other/undetermined sources. Specifically, 55.4% of women reported receiving opioids from an obstetrician-gynecologist, midwife, or prenatal care provider and 26% from an emergency department doctor. The two most commonly reported non-healthcare provider sources were having pain relievers left over from an old prescription (5.4%) and obtaining the pain relievers without a prescription some other way (3.0%).
Among women who used prescription opioids, 88.8% reported using the opioids for pain reasons, 14.4% for reasons other than pain, and 4.9% for other/undetermined reasons. In particular, prescription opioids were used to relieve pain from an injury, condition, or surgery that occurred before (22.2%) or during (63.8%) pregnancy or during an unstated time frame (11.7%). Commonly reported reasons for use other than pain were to help sleep (7.9%) and relieve tension or stress (7.7%).
According to the authors, 68.1% of the women reported that a healthcare provider counseled them about the effect of the use on an infant. The prevalence of receiving counseling did not vary by most maternal characteristics assessed except that a lower proportion of women with no previous live births received counseling than did those with one or more previous births (62.0% versus 71.6%), shows analysis.
The CDC and the American College of Obstetricians and Gynecologists (ACOG) recommends that clinicians and patients discuss and carefully weigh risks and benefits when considering the initiation of opioid therapy for chronic pain during pregnancy. “Opioids, if indicated, should be prescribed only after consideration of alternative pain management therapies. The risk for physiologic dependence and the possibility of an infant developing neonatal opioid withdrawal syndrome should be discussed,” they say.
The experts are also advising clinicians, who care for pregnant women, to perform verbal screening for identifying and addressing substance use, misuse, and substance use disorders. “Co-occurring use of other substances (such as tobacco) and mental health conditions are more common among pregnant women who are prescribed or misusing prescription opioids than among those who are not). Recommended screening and, if applicable, treatment and referral for depression, history of trauma, posttraumatic stress disorder, and anxiety should occur,” suggests the agency.
Due to the possible risk for spontaneous abortion and premature labor associated with opioid withdrawal, the researchers are encouraging clinicians to consult with other healthcare providers as necessary if they consider tapering opioids during pregnancy. “Effective public health strategies to support the implementation of evidence-based guidelines might include improving state prescription drug monitoring program use, provider training, multidisciplinary state learning communities, quality improvement collaboratives, and consumer awareness,” the authors recommend.