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Increase in Prescription Opioid Use During Pregnancy Among Medicaid-Enrolled Women

Desai, Rishi J. MS, PhD; Hernandez-Diaz, Sonia MD, DrPH; Bateman, Brian T. MD, MSc; Huybrechts, Krista F. MS, PhD

doi: 10.1097/AOG.0000000000000208
Contents: Original Research

OBJECTIVE: To report the prevalence of prescription opioid use and evaluate the trends in a large cohort of Medicaid-enrolled pregnant women.

METHODS: A cohort of pregnancies was identified using data from the Medicaid Analytical eXtract for the period of 2000–2007. Dispensing of opioids, as a class and separately for individual agents, was evaluated using claims from filled prescriptions. Variations in patterns of prescription opioid fills were examined by demographic characteristics, by geographic region, and over time. Median number of opioid prescriptions dispensed and cumulative days of availability for prescription opioids during pregnancy were reported.

RESULTS: The study population consisted of more than 1.1 million women with completed pregnancies from 46 U.S. states and Washington, DC. One of five women from our cohort (21.6%) filled a prescription for an opioid during pregnancy; this proportion increased from 18.5% in 2000 to 22.8% in 2007. Substantial regional variation was seen with the proportion of women who filled a prescription during pregnancy, ranging between 9.5% and 41.6% across the states. Codeine and hydrocodone were the most commonly prescribed opioids. Among women filling at least one opioid prescription, the median (interquartile range) number of prescriptions filled was 1 (1–2) and the median (interquartile range) cumulative days of opioid availability during pregnancy were 5 (3–13) days.

CONCLUSION: We observed high and increasing number of filled prescriptions for opioids during pregnancy among Medicaid-enrolled women. These findings call for further safety evaluations of these drugs and their effects on the developing fetus to inform clinical practice.

LEVEL OF EVIDENCE: II

There are high and increasing numbers of filled prescriptions for opioids during pregnancy among Medicaid-enrolled women.

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, the Department of Epidemiology, Harvard School of Public Health, and the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Corresponding author: Rishi J. Desai, MS, PhD, Postdoctoral Research Fellow, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030-R, Boston, MA 02120; e-mail: rdesai2@partners.org.

Supported by Agency for Healthcare Research & Quality Award R01 HSO18533. Brian T. Bateman received additional funding through a K-award (K08HD075831) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, and Krista F. Huybrechts received additional funding through a K-award (K01 MH099141) from the National Institute of Mental Health.

The authors thank Helen Mogun, MS (Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, Massachusetts) for preparing the analytic data set.

Financial Disclosure Dr. Hernandez-Diaz has consulted for Novartis, AstraZeneca, and GSK_biologics for unrelated projects. Dr. Bateman is supported through a K-award (K08HD075831 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The other authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.