Skip to main content

Advertisement

SpringerLink
Log in

Clinical Correlates of Prescription Opioid Analgesic Use in Pregnancy

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

A 2012 committee opinion from the American College of Obstetricians and Gynecologists highlights the considerable increase in opioid addiction in recent years, yet little is known about clinical correlates of prescribed opioids among pregnant women. This study examines clinical and demographic factors associated with the use of opioid analgesics in pregnancy. Data were derived from a prospective cohort study of pregnant women. Participants were administered the Composite International Diagnostic Interview to identify depressive and anxiety disorders and data on medication use were gathered at three assessment points and classified according to the Anatomical Therapeutic Chemical Code (ATC) classification system ATC group N02A. Participants included 2,748 English or Spanish speaking pregnant women. Six percent (n = 165) of women used opioid analgesics at any point in pregnancy. More pregnant women using opioids met diagnostic criteria for major depressive disorder (16 vs. 8 % for non users), generalized anxiety disorder (18 vs. 9 % for non users), post-traumatic stress disorder (11 vs. 4 % for non users) and panic disorder (6 vs. 4 % for non users). Women who reported opioid use were also significantly more likely than non users to report using illicit drugs and almost three times as likely to report smoking cigarettes in the second or third trimester of pregnancy (4 and 23 %, respectively) as compared to non-opioid users (0.5 and 8 %). The use of opioids in pregnancy was associated with higher levels of psychiatric comorbidity and use of other substances as compared to non-opioid users.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. National Center on Addiction and Substance Use. (2006). Controlled prescription drug abuse at epidemic level. Journal of Pain and Palliative Care Pharmacotherapy, 20, 61–64.

    Google Scholar 

  2. Becker, W., Sullivan, L., Tetrault, J., Desai, R., & Fiellin, D. (2008). Non-medical use, abuse and dependence on prescription opioids among U.S. adults: Psychiatric, medical and substance use correlates. Drug and Alcohol Dependence, 94(1–3), 38–47.

    Article  PubMed  Google Scholar 

  3. Compton, W., & Volkow, N. (2006). Major increases in opioid analgesic abuse in the United States: concerns and strategies. Drug and Alcohol Dependence, 81, 103–107.

    Article  PubMed  Google Scholar 

  4. Compton, W., & Volkow, N. (2006). Abuse of prescription drugs and the risk of addiction. Drug and Alcohol Dependence, 83S, S4–S7.

    Article  Google Scholar 

  5. Kuehn, B. (2007). Opioid prescriptions soar: Increase in legitimate use as well as abuse. JAMA, 297(3), 249–251.

    CAS  PubMed  Google Scholar 

  6. Blanco, C., Alderson, D., Ogburn, E., Grant, B. F., Nunes, E. V., Hatzenbuehler, M. L., et al. (2007). Changes in the prevalence of non-medical prescription drug use and drug use disorders in the United States: 1991–1992 and 2001–2002. Drug and Alcohol Dependence, 90(2–3), 252.

    Article  PubMed  Google Scholar 

  7. SAMHSA SAaMHSA. (2007). Results from the 2007 National Survey on Drug Use and Health: National findings (pp. 1–290). Rockville, MD: Office of Applied Studies..

  8. Manchikanti, L., & Singh, A. (2008). Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician, 9(4), 287–321: (11: S63–S88).

  9. Hall, A., Logan, J., Toblin, R., Kaplan, J., Kraner, J., & Bixler, D. (2008). Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA, 300(22), 2613–2620.

    Article  CAS  PubMed  Google Scholar 

  10. Bateman, B., Hernandez-Diaz, S., Rathmell, J., Seeger, J., Doherty, M., Fischer, M., et al. (2014). Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States. Anesthesiology (on line first).

  11. Andrade, S., Gurtwitz, J., & Davis, R. (2004). Prescription drug use in pregnancy. American Journal of Obstetrics and Gynecology, 191, 398–407.

    Article  PubMed  Google Scholar 

  12. Mitchell, A., Gilboa, S., Werler, M., Kelley, K., Louik, C., & Hernandez-Diaz, S. (2011). National Birth Defects Prevention Study: Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. American Journal of Obstetrics and Gynecology, 205(51), e1–e8.

    PubMed  Google Scholar 

  13. Reynolds, E., Riel-Romero, R., & Bada H. (2007). Neonatal abstinence syndrome and cerebral infarction following maternal codeine use during pregnancy. Clinical pediatrics, 46, 639–645.

  14. Jones, H. E., Kaltenbach, K., Heil, S. H., Stine, S. M., Coyle, M. G., Arria, A. M., et al. (2010). Neonatal abstinence syndrome after methadone or buprenorphine exposure. New England Journal of Medicine, 363(24), 2320–2331.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Finnegan, L. P. (1991). Treatment issues for opioid-dependent women during the perinatal period. Journal of Psychoactive Drugs, 23(2), 191–201.

    Article  CAS  PubMed  Google Scholar 

  16. Creanga, A. A. (2012). maternal drug use and its effect on neonates: A population-based study in Washington State. Obstetrics and Gynecology, 119(5), 924.

    Article  PubMed  Google Scholar 

  17. Minnes, S. (2011). Prenatal tobacco, marijuana, stimulant, and opiate exposure: Outcomes and practice implications. Addiction science & clinical practice, 6(1), 57.

    Google Scholar 

  18. Quesada, O., Gotman, N., Howell, H. B., Funai, E. F., Rounsaville, B. J., & Yonkers, K. A. (2012). Prenatal hazardous substance use and adverse birth outcomes. The Journal Of Maternal-Fetal & Neonatal Medicine: The Official Journal Of The European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet, 25(8), 1222–1227.

    Article  Google Scholar 

  19. Stanhope, T., Gill, L., & Rose, C. (2013). Chronic opioid use during pregnancy: Maternal and fetal implications. Clinics in Perinatology, 40, 337–350.

    Article  PubMed  Google Scholar 

  20. Wu, L., Woody, G., Yang, C., & Blazer, D. (2010). Subtypes of nonmedical opioid users: Results from the national epidemiologic survey on alcohol and related conditions. Drug and Alcohol Dependence, 112, 69–80.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Cicero, T., Lynskey, M., Todorov, A., Inciardi, J., & Surratt, H. (2008). Co-morbid pain and psychopathology in males and females admitted to treatment for opioid and analgesic abuse. Pain, 39, 127–135.

    Article  Google Scholar 

  22. Back, S., Payne, R., Simpson, A., & Brady, K. (2010). Gender and prescription opioids: Findings from the National Survey on Drug Use and Health. Addictive Behaviors, 35, 1001–1007.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Handal, M., Engeland, A., Ronning, M., Skurtveit, S., & Furu, K. (2011). Use of prescribed opiod analgesics and co-medication with bensodiazepines in women before, during, and after pregnancy: a population-based cohort study. European Journal of Clinical Pharmacology, 67, 953–960.

    Article  CAS  PubMed  Google Scholar 

  24. Yonkers, K. A., Norwitz, E. R., Smith, M. V., Lockwood, C. J., Gotman, N., Luchansky, E., et al. (2012). Depression and serotonin reuptake inhibitor treatment as risk factors for preterm birth. Epidemiology, 23(5), 677–685.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kessler, R., & Üstün, T. B. (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). The International Journal of Methods in Psychiatric Research, 13(2), 93–121.

    Article  Google Scholar 

  26. Falsetti, S., Resnick, H., Pesick, P., & Kilpatrick, D. (1993). The modified PTSD symptom scale: A brief self-report measure of posttraumatic stress disorder. Behavior Therapist, 16, 161–162.

    Google Scholar 

  27. WHO. (2010). Collaborating center for drug statistics methodology. ATC Classification Index with DDDs.

  28. Tuten, M., Heil, S. H., O’Grady, K. E., Fitzsimons, H., Chisolm, M. S., & Jones, H. E. (2009). The impact of mood disorders on the delivery and neonatal outcomes of methadone-maintained pregnant patients. [Erratum appears in Am J Drug Alcohol Abuse. 2010 Sep; 36(5):304]. American Journal of Drug and Alcohol Abuse, 35(5), 358–363.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Lund, I., Skurtveit, S., Sarfi, M., Bakstad, B., Welle-Strand, G., & Ravndal, E. (2011). A two-year prospective study of psychological distress among a national cohort of pregnant women in opioid maintenance treatment and their partners. Journal of Subst Use, 10, 639–645.

  30. Lund, I. O., Skurtveit, S., Engeland, A., Furu, K., Ravndal, E., & Handal, M. (2013). Prescription drug use among pregnant women in opioid maintenance treatment. Addiction, 108(2), 367–376.

    Article  PubMed  Google Scholar 

  31. Daw, J. R., Hanley, G. E., Greyson, D. L., & Morgan, S. G. (2011). Prescription drug use during pregnancy in developed countries: A systematic review. Pharmacoepidemiology and Drug Safety, 20(9), 895–902.

    PubMed Central  PubMed  Google Scholar 

  32. Donati, S., Baglio, G., Spinelli, A., & Grandolfo, M. E. (2000). Drug use in pregnancy among Italian women. European Journal of Clinical Pharmacology, 56(4), 323–328.

    Article  CAS  PubMed  Google Scholar 

  33. Headley, J., Northstone, K., Simmons, H., Golding, J., & Team, A. S. (2004). Medication use during pregnancy: Data from the Avon Longitudinal Study of Parents and Children. European Journal of Clinical Pharmacology, 60(5), 355–361.

    Article  CAS  PubMed  Google Scholar 

  34. Colvin, L., Slack-Smith, L., Stanley, F. J., & Bower, C. (2009). Pharmacovigilance in pregnancy using population-based linked datasets. Pharmacoepidemiology and Drug Safety, 18(3), 211–225.

    Article  PubMed  Google Scholar 

  35. Gagne, J., Maio, V., Berghella, V., Louis, D., & Gonnella, J. (2008). Prescription drug use during pregnancy: A population-based study in Regione Emilia-Romagna, Italy. European Journal of Clinical Pharmacology, 64(11), 1125–1132.

    Article  PubMed  Google Scholar 

  36. Lacroix, I., Hurault, C., Sarramon, M. F., Guitard, C., Berrebi, A., Grau, M., et al. (2009). Prescription of drugs during pregnancy: A study using EFEMERIS, the new French database. European Journal of Clinical Pharmacology, 65(8), 839–846.

    Article  CAS  PubMed  Google Scholar 

  37. Riley, E., Fuentes-Afflick, E., & Jackson, R. (2005). Correlated of prescription drug use during pregnancy. Journal of Womens Health, 14, 401–409.

    Article  Google Scholar 

  38. Broussard, C. S., Rasmussen, S. A., Reefhuis, J., Friedman, J. M., Jann, M. W., Riehle-Colarusso, T., et al. (2011). Maternal treatment with opioid analgesics and risk for birth defects. American journal of obstetrics and gynecology, 204(4), 314.e1–314.e11.

    Article  Google Scholar 

  39. Nezvalova-Henriksen, K., Spigset, O., & Nordeng, H. (2011). Effects of codeine on pregnancy outcome: Results from a large population-based cohort study. European Journal of Clinical Pharmacology, 67(12), 1253–1261.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  40. Martin, S., Keyes, K., Storr, C., Zhu, H., & Chilcoat, H. (2009). Pathways between nonmedical opioid use/dependence and psychiatric disorders: Results from the National Epidemiologic Survey on alcohol and related conditions. Drug and Alcohol Dependence, 103, 16–24.

    Article  Google Scholar 

  41. Schepis, T., & Hakes, J. (2011). Non-medical prescription use increases the risk for the onset and recurrence of psychopathology: Results from the National Epidemiological Survey on Alcohol and Related Conditions. Addiction, 106, 2146–2155.

    Article  PubMed  Google Scholar 

  42. Grote, N. K., Bridge, J. A., Gavin, A. R., Melville, J. L., Iyengar, S., & Katon, W. J. (2010). A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Archives of General Psychiatry, 67(10), 1012–1024.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Wisner, K., Sit, D., Hanusa, B., Moses-Kolko, E., Bogen, D., Hunker, D., et al. (2009). Major Depression and Antidepressant Treatment: Impact on Pregnancy and Neonatal Outcomes. American Journal of Psychiatry, 166, 557–566.

    Article  PubMed  Google Scholar 

  44. Sarangarm, P., Young, B., Rayburn, W., Jaiswal, P., Dodd, M., Phelan, S., et al. (2012). Agreement between self-report and prescription data in medical records for pregnant women. Birth Defects Research (Part A), 94, 153–161.

    Article  CAS  Google Scholar 

  45. McCabe, S., Boyd, C., & Teter, C. (2009). Subtypes of nonmedical prescription drug misuse. Drug and Alcohol Dependence, 102, 63–70.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Barrett, S., Meisner, J., & Stewart, S. (2008). What constitutes prescription drug misuse? Problems and pitfalls of current conceptualizations. Current Drug Abuse Reviews, 1, 255–262.

    Article  PubMed  Google Scholar 

  47. Catalono, R., White, H., Fleming, C., & Haggery, K. (2011). Is nonmedical prescription opiate use a unique form or illict drug use? Addictive Behaviors, 36, 79–86.

    Article  Google Scholar 

  48. Winklbaur, B., Kopf, N., Ebner, N., Jung, E., Thau, K., & Fischer, G. (2008). Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: A knowledge synthesis for better treatment for women and neonates. Addiction, 103(9), 1429–1440.

    Article  PubMed  Google Scholar 

  49. American College of Obstetricians & Gynecologists. (2012). Opioid abuse, dependence, and addiction in pregnancy.

  50. Jones, H. (2013). Treating opioid use disorders during pregnancy: Historical, current, and future directions. Substance Abuse, 34(2), 89–91.

    Article  PubMed  Google Scholar 

  51. Morgan, M., Cragan, J., Goldenberg, R., Rasmussen, S., & Schulkin, J. (2010). Management of prescription and nonprescription drug use during pregnancy. The Journal of Maternal-Fetal and Neonatal Medicine, 23(8), 813–819.

    Article  PubMed  Google Scholar 

  52. Jansson, L., & Velez, M. (2012). Neonatal abstinence syndrome. Current Opinion in Pediatrics, 24(2), 252–258.

Download references

Acknowledgments

K12 DA031050 (Smith) and R01 HD045735.

Conflict of interest

Dr. Yonkers has the following conflicts to disclose: she has received study medication from Pfizer for an NIMH trial and has received royalties from Up to Date. All other investigators do not have any conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Yale School of Medicine, 300 George Street, 9th floor, New Haven, CT, 06511, USA

    Megan V. Smith, Darce Costello & Kimberly A. Yonkers

Authors
  1. Megan V. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Darce Costello
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kimberly A. Yonkers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Megan V. Smith.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smith, M.V., Costello, D. & Yonkers, K.A. Clinical Correlates of Prescription Opioid Analgesic Use in Pregnancy. Matern Child Health J 19, 548–556 (2015). https://doi.org/10.1007/s10995-014-1536-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-014-1536-6

Keywords

Search

Navigation