Opioids in pregnancy ‘need best practice prescribing’

Pregnant women are at high risk of being prescribed opioid medication inappropriately, a new analysis has found.

The new American study found that nearly 10 percent of women on Medicaid, the US health insurance plan, who had live births received a prescription for opioids. The study by New York researchers focused on women of reproductive age from 2008 to 2013 and was published in Morbidity and Mortality Weekly Report.

The study also found that opioids were prescribed to 17.3% of women who were not on contraceptives, but who did not give birth during the reporting year. Among women who were on contraceptives or infertile, that figure was 27.3%. Overall, 20% of women of reproductive age had been prescribed opioids.

Opioids in pregnancy ‘need best practice prescribing’

“Although opioid prescribing is lowest for women who are pregnant, without further study it is not clear that all prescribing for these women remains best practice,” said lead author Brian Gallagher, program research specialist in the Office of Quality and Patient Safety at the New York State Department of Health.

A previous study had found a much higher rate of prescriptions for Medicaid recipients elsewhere in the United States. During 2008-2012, an estimated 39.4% of reproductive-aged women enrolled in Medicaid in a selection of U.S. states received opioid prescription,” according to that study.

Dr Brian Bateman, associate professor of anaesthesia at Harvard Medical School, in Boston, said the new study is “a helpful contribution to the literature.”

“We’ve seen data before that suggested that the frequency with which women use opioids during pregnancy is quite high, and this study confirms those findings.” He added that another study conducted by Dr Bateman’s group in a commercially insured population found that 14% received a prescription for an opioid during pregnancy.

Opioids during pregnancy have led to a rising incidence of neonatal abstinence syndrome. A 2015 paper in the New England Journal of Medicine found that the rate of neonatal ICU (NICU) admissions rose from seven of 1,000 in 2004 to 27 of 1,000 in 2013. For some centres, more than 20% of NICU days were attributable to the care of neonatal abstinence syndrome.

There is limited knowledge of the damaging effects incurred by opioids during pregnancy in terms of birth defects, pregnancy outcomes and even long-term neurodevelopmental problems, said Dr Bateman.The uncertainties surrounding opioids’ potentially damaging effects during pregnancy mean that they should be used very carefully.

Leave a comment