Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct;122(4):838-844.
doi: 10.1097/AOG.0b013e3182a6643c.

Periconceptional use of opioids and the risk of neural tube defects

Mahsa M Yazdy  1 , Allen A Mitchell, Sarah C Tinker, Samantha E Parker, Martha M Werler
Affiliations

Periconceptional use of opioids and the risk of neural tube defects

Mahsa M Yazdy et al. Obstet Gynecol. 2013 Oct.

Abstract

Objective: Opioid medications are among the most effective analgesics. However, the consequences of opioid exposure to the developing human offspring are not known. We assessed whether maternal opioid use in the periconceptional period was associated with the risk of neural tube defects in the offspring.

Methods: We used data from 1998 to 2010 from the Slone Epidemiology Center Birth Defects Study, an ongoing case-control study. Mothers were interviewed by telephone within 6 months of delivery about sociodemographic factors and exposures during pregnancy including detailed questions on type and timing of medication use. Mothers of 305 offsprings with neural tube defect were compared with mothers of 7,125 offsprings in the nonmalformed control group and 13,405 offsprings in the malformed control group. Periconceptional opioid use was defined as any reported use in the 2 months after the last menstrual period. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for study center.

Results: A higher percentage of mothers of offsprings with neural tube defects (3.9%) reported using an opioid medication than mothers of offsprings in the nonmalformed control group (1.6%) and offsprings in the malformed control group (2.0%) with adjusted ORs of 2.2 (95% CI 1.2 -4.2) and 1.9 (95% CI 1.0 -3.4), respectively. When offsprings were restricted to those with spina bifida, the adjusted ORs were 2.5 (95% CI 1.3-5.0) and 2.2 (95% CI 1.1-4.1), respectively.

Conclusion: A 2.2-fold increase in risk would translate to a neural tube defect prevalence of 5.9 per 10,000 live births among women who use opioids. Overall, opioid use in the periconceptional period appeared to be associated with a modest increased risk of neural tube defects.

Level of evidence: : II.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure

Dr. Werler is on advisory boards of manufacturer-sponsored studies that evaluate pregnancy outcomes among women treated with medications for rheumatoid arthritis. Dr. Mitchell owned stock (until August 2012) in Johnson & Johnson, which markets various analgesics; he also serves on the advisory committee of the Biogen-Idec, Tysabri Pregnancy Registry. The other authors did not report any potential conflicts of interest.

Comment in

References

    1. Kuehn BM. Opioid prescriptions soar. JAMA. 2007;297:249–251. - PubMed
    1. Manchikanti L. National drug control policy and prescription drug abuse: facts and fallacies. Pain Physician. 2007;10:399–424. - PubMed
    1. Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008;11(suppl):S63–S88. - PubMed
    1. Kelley K, Kelley T, Kaufman D, Mitchell A. The Slone DrugDictionary: a research driven pharmacoepidemiology tool. Pharmacoepidemiol Drug Saf. 2003;12(suppl 1):S168–S169.
    1. Munoz MA, Stojanovic D, Etminan M, Winterstein AG, Delaney J. Trends in use of benzodiazepines, opioids, tramadol, and Z-drugs from 1998 to 2008 in a managed care population. Pharmacoepidemiol Drug Saf. 2012;21(suppl 3):426.

Publication types

Substances