Studies of opioid exposure in pregnancy suggest increased risk for adverse pregnancy outcomes, neonatal abstinence syndrome, and birth defects (including neural tube defects and congenital heart defects). Birth defects result from exposures which occur during the first few weeks of pregnancy, when many women are not aware that they are pregnant. Therefore, the CDC urges health care providers to assess opioid medication use in all women of reproductive age.
The CDC reviewed Truven Health’s MarketScan Commercial Claims and Encounters and Medicaid data to estimate the number of opioid prescriptions dispensed by outpatient pharmacies to women between the ages of 15 and 44. During 2008–2012, opioid prescriptions were more common among Medicaid-enrolled women than in privately insured women (39.4% compared with 27.7%, p<0.001). The most frequently prescribed opioids among women in both groups were hydrocodone, codeine, and oxycodone. Significant regional and racial/ethnic differences were observed. Among privately insured women, opioid prescription claims were highest among those residing in the South. Among Medicaid-enrolled women, opioid prescription claims were highest among non-Hispanic whites (p<0.001).
The authors of the report also remark that the consistently higher frequency of opioid prescriptions among Medicaid-enrolled women is of concern because approximately 50% of U.S. births occur to Medicaid-enrolled women. Previous studies have, in fact, demonstrated higher rates of opioid use during pregnancy among women receiving Medicaid. In one study of approximately 534,000 pregnant women with private insurance (2005–2011), 14.4% filled a prescription for an opioid during pregnancy. In contrast, among 1.1 million Medicaid-enrolled women (2000–2007), 21.6% filled a prescription for an opioid during pregnancy.
Given these findings, the CDC recommends that efforts are needed to promote interventions designed to reduce opioid prescriptions among women of childbearing age when safer alternative treatments are available.
Ruta Nonacs, MD PhD