The number of pregnant women who abuse or are dependent on opioids (narcotics) jumped 127 percent in 14 years, leading to an increased risk of maternal death and stillbirth among other serious problems, according to a review of more than 57 million American women admitted for delivery. The results were published in the December issue of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®).
Opioid abuse or dependence in pregnant women more than doubled between 1998 and 2011, and was even greater among 20- to 34-year olds, growing by 162 percent in that time period. In addition to maternal deaths and stillbirths, the use of opioids was also associated with poor growth of the fetus, longer length of stay in the hospital, premature labor and cesarean delivery.
"Opioid abuse and dependence has grown dramatically in the general U.S. population, and our findings show that this epidemic extends to pregnant women," said Lisa R. Leffert, M.D., lead author of the study and chief of obstetric anesthesia at Massachusetts General Hospital, Boston. "More research is needed to understand the factors leading to opioid abuse and dependence in these women and the ways in which we can help to mitigate the complications associated with these issues during pregnancy and childbirth."
About one in seven women is prescribed opioids during pregnancy, according to a previous study by the same authors. For this study, the researchers analyzed data from the Nationwide Inpatient Sample (NIS), including nearly 57 million pregnant women admitted to U.S. hospitals for delivery between 1998 and 2011. At the beginning of the study, 1.7 of every 1,000 women abused or were dependent on opioids at the time of labor, and 14 years later, that number increased to 3.9 per 1,000 delivery admissions. The increase was greatest in women 20- to 34-years old: the number of women of that age dependent on or abusing opioids grew from 1.8 to 4.5 out of every 1,000 deliveries.
Reviewing data from the last five years of the NIS, the researchers found that women who abused or were dependent on opioids were nearly five-fold more likely to die during hospitalization, and were more likely to deliver by cesarean and have extended hospital stays than those who did not abuse or were not dependent on narcotics. Further, their babies were about twice as likely to be stillborn, preterm (born early), and have intrauterine growth restriction (poor growth). In addition, placental abruption (when the placenta separates from the wall of the uterus prematurely) was almost three times more common in these patients. These associations largely remained when opioid abusing or dependent women were compared to non-opioid drug abusing or dependent women.
"Our study shows that these patients are at very high risk for developing complications. Given the rapid rise in opioid abuse and dependence in these patients, there is an urgent need to understand the link with bad outcomes and to develop interventions to help prevent them," said Dr. Leffert
American Society of Anesthesiologists