Is Prescription Opioid Use Increasing in Pregnant Women?

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Is Prescription Opioid Use Increasing in Pregnant Women?Prescription opioids are widely prescribed medications commonly used to relieve medically serious pain. In the U.S., these medications rank as the most frequently abused legitimate pharmaceutical substances. Pregnant women who use prescription opioid medications have increased risks for bearing children with any one of a number of serious birth defects. However, according to the results of studies published in two journals in May 2014, intake of these medications by pregnant women commonly occurs. One of the studies covers usage patterns among women participating in the publicly funded insurance plan called Medicaid, while the other covers usage patterns among women with private health insurance.

Opioid Basics

Opioid medications in frequent use in the U.S. include codeine, fentanyl (Duragesic, Actiq), hydrocodone (Vicodin, Lortab) and oxycodone (Percodan, OxyContin). Data compiled by the Substance Abuse and Mental Health Services Administration indicate that about 1.9 percent of all American teenagers and adults abuse a prescription opioid on a monthly basis. Even when grouped together, the rates of abuse for the next three most commonly misused medication types (tranquilizers, stimulants and sedatives) do not match this total. In fact, among all illegal/illicit substances (a category that excludes both alcohol and cigarettes/nicotine), only marijuana has a higher level of popularity. Two of the most widely prescribed opioid medications, oxycodone and hydrocodone, are particularly common targets of abuse by both valid prescription holders and people who don’t have an opioid prescription.

Potential Effects on Pregnancy

Birth defects associated with the use of prescription opioids during pregnancy include hydrocephaly (fluid accumulation in the brain), glaucoma, spina bifida and six separate forms of heart-related defects. Potential consequences of these defects include such things as blindness, disrupted or delayed growth and development, a reduced ability to digest food, paralysis and death, as well as increased risks for heartbeat irregularities, strokes or heart failure during adulthood.

Despite the potential for complications, doctors still sometimes prescribe opioids to pregnant women for purposes such as the treatment of physical injuries, relief of surgery-related pain, relief of chronic pain and relief of infection-related pain. The specific medications most commonly prescribed to women during pregnancy are hydrocodone and codeine. As a rule, doctors attempt to balance the risks associated with these and other opioids with their potential treatment benefits.

The American College of Obstetricians and Gynecologists estimates that roughly 1 percent of all pregnant women in the U.S. abuse a prescription opioid painkiller. All such women run the risk of developing an opioid addiction. In addition, an addicted pregnant woman who suddenly stops using opioids can develop serious complications that include premature birth, fetal endangerment and a miscarriage or stillbirth.

Is Prescription Painkiller Use Increasing?

In a study published in May 2014 in the journal Obstetrics & Gynecology, researchers from Harvard-affiliated Brigham and Women’s Hospital used data gathered between 2000 and 2007 to track the rate of prescription opioid use among pregnant women receiving publicly funded insurance through Medicaid. All told, this data covered 1.1 million pregnancies.

In 2000, 18.5 percent of the participating women took a prescribed opioid medication during pregnancy; by 2007, this number had increased to 22.8 percent. On a state-by-state basis, the rate of usage varied from a low of 9.5 percent to a high of 41.6 percent. The average duration of prescription opioid use was five days. The study’s authors characterized the pattern of opioid medication use among pregnant women receiving Medicaid as “high and increasing.”

In a study published in May 2014 in the journal Anesthesiology, researchers from another Harvard-affiliated institution, Massachusetts General Hospital, looked at the rate of prescription opioid medication use among 534,500 pregnant women with private insurance between 2005 and 2011. Roughly 14.9 percent of all the women under consideration used a prescription opioid in 2005; by 2011, this number had fallen slightly to 12.9 percent. Despite this decline, the study’s authors characterized the use of opioid medications among pregnant women with private insurance as “very common.”

Significance and Considerations

In addition to hydrocodone and codeine, pregnant women with private insurance often also receive prescriptions for oxycodone, the authors of the study published in Anesthesiology report. The authors of both studies cite incomplete knowledge of the full range of dangers associated with using prescriptions opioids during pregnancy and call for additional research to complete the picture of exactly how these medications can interfere with the delivery of healthy newborns.