The research involving 251,000 pregnant women enrolled in Tennessee Medicaid and without OUD found that a positive association was found between total prescription opioid dose dispensed and the odds of spontaneous preterm birth. Vanderbilt University Medical Center investigators and colleagues caution, “These findings support guidance to minimize opioid exposure during pregnancy and prescribe the lowest dose necessary.”
The study was published in Journal of the American Medical Association Network Open.
The authors pointed out that while opioid exposure during pregnancy has been associated with preterm birth, previous studies did not differentiate between spontaneous and indicated preterm birth. The prior research also did not fully investigate the associations as functions of opioid dose, they added.
That is why the study team sought to determine whether prescription opioid use during pregnancy is associated with spontaneous preterm birth and whether the association is dose dependent. To do that, the case-control study examined a retrospective cohort of pregnant patients enrolled in Tennessee Medicaid.
Researchers linked enrollment files to healthcare encounters, hospital discharge information, birth certificate data, and prescription fills.
Eligible participants were pregnant women aged 15 to 44 years without OUD who experienced the birth of a single fetus at 24 weeks’ gestation or greater between 2007 and 2019 with linked birth certificate data. Any cases of spontaneous preterm birth were matched with up to 10 controls based on pregnancy start date, race, ethnicity, age at delivery within 2 years, and history of prior preterm birth.
The focus was on total opioid morphine milligram equivalents (MME) filled during the 60 days prior to the index date. The primary outcome was defined as spontaneous preterm birth determined by a validated algorithm using birth certificate data.
The study identified 25,391 cases with spontaneous preterm birth, and these were identified and matched with 225,696 controls. The cases had a median age of 23 years and were 58.1% non-Hispanic white, 38.7% black, 2.6% Hispanic, and 0.5% Asian, while controls were similar demographically.
The study found that 7.4% of the participants filled an opioid prescription in the 60 days prior to the index date. “Each doubling of nonzero opioid MME was associated with a 4% increase in the odds of spontaneous preterm birth compared with no opioid exposure (adjusted odds ratio, 1.04; 95% CI, 1.01-1.08),” according to the researchers.
Acute pain management is difficult during pregnancy because of limited pharmacologic treatments beyond acetaminophen for moderate-to-severe pain; nonsteroidal anti-inflammatory drugs have known fetal risks.
“Clinicians are left with opioid medications as the primary pharmacological treatment to treat pain not controlled with acetaminophen, and this has likely contributed to high rates of opioids prescribed during pregnancy in the U.S.,” the authors explained. “Some studies report that up to 21% of pregnant patients use opioids at some point in their pregnancy.”
The current investigation was novel because it looked at the impact of short-prescription opioid exposure for acute episodes of pain on other perinatal outcomes.
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