Opioids Commonly Dispensed During Pregnancy

Despite limited evidence on whether use of opioid painkillers during pregnancy is safe, a new study finds that approximately 1 in 7 women is exposed to the medications during pregnancy.

Although the effects of opioid painkiller use during pregnancy are largely unknown, approximately 14% of women receive a prescription for the medications at some point during their pregnancy, according to the results of a recent study.

The study, published online on February 12, 2014, in Anesthesiology, determined the prevalence of opioid use in a large cohort of pregnant women who gave birth from 2005 to 2011. Using a de-identified research database of insurance beneficiaries from across the country, the researchers analyzed the type of opioids dispensed to women before they became pregnant, during each trimester, and during pregnancy overall, and estimated the expected duration of exposure based on pharmacy dispensing records. The analysis included hydrocodone, codeine, oxycodone, propoxyphene, fentanyl, buprenorphine, methadone, pentazocine, tapentadol, and oxymorphone.

Of the 534,500 women included in the study, 76,742 (14.4%) were dispensed an opioid at some point during their pregnancy. When analyzed by trimester, 5.7% of women received the painkillers during their first trimester, 5.7% received them during their second trimester, and 6.5% received them during their third trimester. Most women used the drugs for short periods of time, but 2.2% of women were dispensed opioids 3 or more times during their pregnancy.

Opioids containing hydrocodone were most commonly dispensed during pregnancy and were given to 6.8% of pregnant women, followed by those containing codeine (6.1%), oxycodone (2%), and propoxyphene (1.6%). Opioids were most frequently prescribed for back pain, accounting for 37% of all women exposed to the painkillers during pregnancy and 61% of those who received the drugs 3 or more times during their pregnancy.

The results of the analysis also indicated a slight decline in opioid use in pregnancy during the study period. Opioid use decreased from 14.9% for women who gave birth in 2005 to 12.9% in 2011. Exposure to the painkillers also varied significantly by region, with the highest prevalence in the South and the lowest prevalence in the Northeast.

Long-term use of opioids during pregnancy has been associated with a risk of neonatal opioid dependence, but research on the safety of short-term use has been inconsistent. Alternative pain treatments, including nonsteroidal anti-inflammatory drugs, have also been associated with potential adverse effects in pregnant women, indicating a need for greater research on the risks and benefits of these therapies during pregnancy, the study authors note.

“Given this continued high use during all phases of pregnancy and the small and inconsistent body of literature on their safety, there is a need for research on the comparative safety of these medications during pregnancy to help inform clinical practice and treatment guidelines,” they conclude.