Alex F Peahl1, Daniel M Morgan2, Vanessa K Dalton3, Kara Zivin4, Yen-Ling Lai5, Hsou Mei Hu5, Elizabeth Langen6, Lisa Kane Low7, Chad M Brummett8, Jennifer F Waljee9, Melissa E Bauer10. 1. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI; National Clinician Scholars Program, Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI. Electronic address: alexfrie@med.umich.edu. 2. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI. 3. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI; Program on Women's Health Care Effectiveness Research (PWHER), University of Michigan, Ann Arbor, MI. 4. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Department of Psychiatry, Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan School of Public Health, and the Institute for Social Research, University of Michigan, Ann Arbor, MI. 5. Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI. 6. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI. 7. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI; School of Nursing, Women's Studies Department, University of Michigan, Ann Arbor, MI. 8. Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI; Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan. 9. Program on Women's Health Care Effectiveness Research (PWHER), University of Michigan, Ann Arbor, MI; Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI; Department of Surgery, University of Michigan, Ann Arbor, MI. 10. School of Nursing, Women's Studies Department, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVE: To evaluate the association between opioid prescribing during pregnancy and new persistent opioid use in the year following delivery. MATERIALS AND METHODS: This nationwide retrospective cohort study included patients aged 12-55 years in Optum's deidentified Clinformatics Data Mart Database who were undergoing vaginal delivery or cesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year postdischarge. Women were included if they were opioid naive in pregnancy (ie, did not fill an opioid prescription 2 years to 9 months before delivery) and did not undergo a procedure within the year after discharge. The exposure was filling an opioid prescription in pregnancy. The primary outcome was new persistent opioid use, defined as a pharmacy claim for ≥1 opioid prescription between 4 and 90 days postdischarge and ≥1 prescription between 91 and 365 days postdischarge. Clinical and demographic covariates were included. Analyses included descriptive statistics and multivariable logistic regression, adjusting for clinical and demographic covariates. RESULTS: Of 158,425 childbirths identified, 101,013 (63.8%) were by vaginal delivery and 57,412 (36.2%) cesarean delivery. Among all patients, 6.0% (9429) filled an opioid prescription during pregnancy. The factors associated with filling an opioid in pregnancy were having a nondelivery procedure in pregnancy (adjusted odds ratio, 9.60; 95% confidence interval, 8.81-10.47) and having an emergency room visit during pregnancy (adjusted odds ratio, 2.48; 95% confidence interval, 2.37-2.59). Of women who received an opioid in pregnancy, 4% (379) developed new persistent opioid use. The factors most associated with new persistent opioid use were receiving an opioid prescription during pregnancy (adjusted odds ratio, 3.45; 95% confidence interval, 3.04-3.92) and filling a peripartum opioid prescription (1 week prior to 3 days postdischarge) adjusted odds ratio, 2.28, 95% confidence interval (2.02-2.57). Though having a procedure during pregnancy was associated with increased receipt of an opioid prescription, it was also associated with reduced new persistent opioid use (adjusted odds ratio, 0.72; 95% confidence interval, 0.52-0.99). CONCLUSION: Women who receive an opioid prescription during pregnancy are more likely to experience new persistent opioid use. Maternity care providers must balance pain management in pregnancy with potential risks of opioids.
OBJECTIVE: To evaluate the association between opioid prescribing during pregnancy and new persistent opioid use in the year following delivery. MATERIALS AND METHODS: This nationwide retrospective cohort study included patients aged 12-55 years in Optum's deidentified Clinformatics Data Mart Database who were undergoing vaginal delivery or cesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year postdischarge. Women were included if they were opioid naive in pregnancy (ie, did not fill an opioid prescription 2 years to 9 months before delivery) and did not undergo a procedure within the year after discharge. The exposure was filling an opioid prescription in pregnancy. The primary outcome was new persistent opioid use, defined as a pharmacy claim for ≥1 opioid prescription between 4 and 90 days postdischarge and ≥1 prescription between 91 and 365 days postdischarge. Clinical and demographic covariates were included. Analyses included descriptive statistics and multivariable logistic regression, adjusting for clinical and demographic covariates. RESULTS: Of 158,425 childbirths identified, 101,013 (63.8%) were by vaginal delivery and 57,412 (36.2%) cesarean delivery. Among all patients, 6.0% (9429) filled an opioid prescription during pregnancy. The factors associated with filling an opioid in pregnancy were having a nondelivery procedure in pregnancy (adjusted odds ratio, 9.60; 95% confidence interval, 8.81-10.47) and having an emergency room visit during pregnancy (adjusted odds ratio, 2.48; 95% confidence interval, 2.37-2.59). Of women who received an opioid in pregnancy, 4% (379) developed new persistent opioid use. The factors most associated with new persistent opioid use were receiving an opioid prescription during pregnancy (adjusted odds ratio, 3.45; 95% confidence interval, 3.04-3.92) and filling a peripartum opioid prescription (1 week prior to 3 days postdischarge) adjusted odds ratio, 2.28, 95% confidence interval (2.02-2.57). Though having a procedure during pregnancy was associated with increased receipt of an opioid prescription, it was also associated with reduced new persistent opioid use (adjusted odds ratio, 0.72; 95% confidence interval, 0.52-0.99). CONCLUSION:Women who receive an opioid prescription during pregnancy are more likely to experience new persistent opioid use. Maternity care providers must balance pain management in pregnancy with potential risks of opioids.
Authors: Hannah Wunsch; Andrea D Hill; Jennifer Bethell; Longdi Fu; Brian T Bateman; Karim S Ladha; Duminda N Wijeysundera; Mark D Neuman Journal: Ann Surg Date: 2021-11-23 Impact factor: 13.787
Authors: Deborah S Keller; Brooke C Kenney; Calista M Harbaugh; Jennifer F Waljee; Chad M Brummett Journal: Surgery Date: 2020-12-04 Impact factor: 3.982