According to the most recent Pregnancy Risk Assessment Monitoring System (PRAMS) survey conducted in 2019, 6.6% of the respondents reported prescription opioid use during pregnancy.  Use of prescription opioids was more common in certain groups. Prescription opioid use was the highest (10%) in women 19 years and under.  Among women who smoked cigarettes during pregnancy, 16% also reported opioid use.  In addition, 13% of women with depression during pregnancy used prescription opioids.

Among women who reported using opioid medications, 21.2% reported misusing prescription opioids (obtaining them from a source other than a healthcare provider and/or using them for reasons other than pain relief).

Given that opioid use during pregnancy has been associated with worse obstetrical outcomes, addressing the use of prescription opioids during pregnancy (ideally before conception) is essential.  Previous studies have suggested a link between opioid exposure and increased risk of certain congenital malformations, including neural tube defects.  In addition, opioid use during pregnancy has been associated with increased risk of maternal cardiac arrest, intrauterine growth restriction, preterm labor, premature rupture of membranes, and stillbirth.  About a third of the women reported that they had received no information from their healthcare provider regarding the risks of using prescription opioids during pregnancy.  

This is not the first study to show relatively high rates of prescription opioid use during pregnancy.  Other studies, looking at pharmacy dispensing claims from commercial insurers and Medicaid, found that 14%–22% of women filled at least one opioid prescription during pregnancy.

Although women are highly motivated to abstain from drug use during pregnancy, they may be hesitant to openly discuss substance use with obstetric providers.  Given women’s concerns about negative appraisals from health care providers and fears that child protective services may be notified, it is likely that many women may not accurately report their usage of substances during pregnancy. Improved screening for opioid use and misuse and more aggressive treatment of opioid use disorder in pregnant patients is essential and may help to reduce the prevalence of adverse pregnancy outcomes in this vulnerable population.

Ruta Nonacs, MD PhD

Prescription Opioid Pain Reliever Use During Pregnancy — 34 U.S. Jurisdictions, 2019

Ko JY, D’Angelo DV, Haight SC, Morrow B, Cox S, Salvesen von Essen B, Strahan AE, Harrison L, Tevendale HD, Warner L, Kroelinger CD, Barfield WD.  Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy – 34 U.S. Jurisdictions, 2019.  MMWR Morb Mortal Wkly Rep. 2020 Jul 17;69(28):897-903. Free article.

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