New research from Oregon Health & Science University found that the rate of opioid use during pregnancy has risen two-fold over the past decade.
The study, published today in the Journal of Addiction Medicine, also identified significantly increased risks of maternal and infant health complications among patients with opioid-related diagnoses in pregnancy.
The United States has one of the highest rates of opioid use globally, and use of the substances in pregnancy is also increasing. Even so, most of the data available on prenatal opioid use is from international studies. Further, studies conducted in the United States have generally focused on a limited set of outcomes.
"Given the prevalence and seriousness of this issue, we were surprised to see the lack of large-scale studies available," said Jamie Lo, M.D., M.C.R., associate professor of obstetrics and gynecology (maternal-fetal medicine) in the OHSU School of Medicine and the study's lead author.
OHSU physician-scientists sought to better understand the modern scope of opioid use in pregnancy and specific health impacts for mothers and infants, which is critical information for providers to be able to improve patient counseling and prenatal care.
Their new study was one of the largest population-based studies to examine both the maternal and infant health outcomes associated with an opioid-related diagnosis in pregnancy over the last decade.
"Sadly, we know many people who are using opioids while pregnant hesitate to ask for help due to the fear of judgement, and we hope to see that change," Lo said. "As providers, our goal is to support patients in a healthy pregnancy and transition to parenthood. These data show that for those struggling with addiction, this should include timely, personalized multi-disciplinary care outside of standard prenatal checkups."
Risks to infant, mother
The large retrospective-cohort study used hospital data from California, encompassing more than 5.5 million patients. OHSU's analysis showed that the prevalence of an opioid-related diagnosis more than doubled from 0.14% in 2008 to 0.33% in 2020, reflecting the alarming increasing national trend of opioid use.
Learn more: OHSU a leader in addiction medicine
The study also found a prenatal opioid-related diagnosis was associated with a significantly higher risk of negative outcomes for the infant, including admission to neonatal intensive care units, respiratory distress, preterm birth and death. This was also true for maternal outcomes: Findings showed that pregnant individuals in this population were at significantly higher risk for severe, unexpected complications such hypertension, hemorrhage or the need for blood transfusions.
Looking forward, the research team hopes to conduct additional studies that explore the unique impacts of opioid use on patients who have other conditions, including mental health disorders or use of other drugs, alcohol or nicotine. Additionally, the research team says there is a need to better understand the impact of opioid class — if substances are natural, semi-synthetic or synthetic — as well as the use timing, method of use and drug potency.
Improving outcomes, strengthening families
To address this growing issue, researchers emphasize that improvements in care access and delivery are urgently needed. Specifically, they note patients shouldn't be seen by an individual provider; rather, care should take a whole-health approach and include addiction medicine, primary care and pediatric health providers.
"Pregnant patients already face a lot of difficulties in accessing care, but individuals with opioid-use disorders face additional barriers. Here in Oregon, only one in four residential treatment programs offer care for pregnant persons, and some counties have no obstetric care or addiction care resources available at all," Kristin Prewitt, M.D., M.P.H., fellow in OHSU's section of addiction medicine and department of maternal-fetal medicine, and the study's co-author.
"Evidence shows that linking patients to care earlier improves outcomes. If we're aware early on that an individual faces these additional risks, we can ensure they receive personalized, multidisciplinary care in the prenatal and postnatal periods, and ultimately when they move onto pediatric care with their child."
This work is already underway in Oregon. Recently, the Oregon Perinatal Collaborative, or OPC, and their partner, Comagine Health, received long-term funding to improve the delivery of substance-use care to pregnant people in inpatient and outpatient settings. Starting in the new year, health systems across the state can sign up to work with OPC to address existing gaps in care and create solutions that better serve the complex needs of individuals and families. These changes will allow patients who need obstetric and substance-use care simultaneously to receive wholistic services in a non-stigmatized environment.
Prewitt says these efforts will impact patients and their families long after pregnancy and delivery.
"Here in Oregon, we have a huge problem of family separation due to addiction, and it's because we don't have adequate access to treatment and care," she said. "We hope our research contributes to the important conversations happening in our state around the issues of addiction and maternal health care and helps create change to better the health and stability of families."
"Dr. Lo, Dr. Prewitt, and colleagues offer new insights into the troubling opioid epidemic in pregnancy with this impactful study. OHSU pledges to reduce stigma around this care when it is needed most," said OHSU President Shereef Elnahal, M.D., M.B.A.
Research reported in this publication was supported by the National Institutes of Health, award number DA056793. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or other funders.
