Pregnant women’s use of opioids is on the rise

Pregnant women aren’t immune to the escalating opioid epidemic.

Data on hospital deliveries in 28 U.S. states shows the rate of opioid use among pregnant women has quadrupled, from 1.5 per 1,000 women in 1999 to 6.5 per 1,000 women in 2014, the U.S. Centers for Disease Control and Prevention reports.

The highest increases in opioid use among pregnant women were in Maine, New Mexico, Vermont and West Virginia, according to the CDC study, published online August 9 in Morbidity and Mortality Weekly Report.
“This analysis is a stark reminder that the U.S. opioid crisis is taking a tremendous toll on families,” says coauthor Jean Ko, a CDC epidemiologist in Atlanta.

In this first look at opioid use during pregnancy by state, Washington, D.C. had the lowest rate in 2014, at 0.7 per 1,000 women, and Vermont had the highest, at 48.6 per 1,000. However, the data from the U.S. Health and Human Services Department represents only the 28 states that record opioid use at childbirth during the studied time frame.

“We knew the incidence was increasing” as the number of babies going through opioid withdrawal has also gone up, says Matthew Grossman, a pediatrician at Yale University. Overall, the number of U.S. deaths attributed to opioids has also been steadily rising (SN: 3/31/18, p. 18). In 2014, there were 14.7 opioid deaths per 100,000 people, up from 6.2 per 100,000 in 2000, according to the CDC.
Taking opioids during pregnancy, especially in the last trimester, increases the risk of preterm birth and stillbirth, as well as infant opioid withdrawal (SN: 6/10/17, p. 16). Pregnant women should tell their doctors if they are taking opioids, so complications can be addressed, says Alison Holmes, a pediatrician at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. Mothers may be prescribed methadone, a synthetic opioid which is safer for the fetus and protects it from going through withdrawal in the womb. “What’s not safe for the child is active opioid misuse,” she says.

Only eight U.S. states require that pregnant women be tested for opioids if substance abuse is suspected, the CDC says. In Cincinnati, all pregnant women are tested at delivery, but it would be even better to test women in the first trimester, says pediatrician Scott Wexelblatt at the Cincinnati Children’s Hospital. “If we could identify a mom at 12 weeks instead of 40 weeks, then we could get her into medicated assisted treatment.”