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. 2014 May;120(5):1216-24.
doi: 10.1097/ALN.0000000000000172.

Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States

Brian T Bateman  1 , Sonia Hernandez-Diaz, James P Rathmell, John D Seeger, Michael Doherty, Michael A Fischer, Krista F Huybrechts
Affiliations

Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States

Brian T Bateman et al. Anesthesiology. 2014 May.

Abstract

Background: There are few data regarding the utilization of opioids during pregnancy. The objective of this study was to define the prevalence and patterns of opioid use in a large cohort of pregnant women who were commercial insurance beneficiaries.

Methods: Data for the study were derived from a deidentified research database of women from across the United States who had both medical and prescription benefits. By using diagnostic codes, the authors defined a cohort of 534,500 women with completed pregnancies who were enrolled in a commercial insurance plan from 6 months before pregnancy through delivery.

Results: Overall, 76,742 women (14.4%) were dispensed an opioid at some point during pregnancy. There were 30,566 women (5.7%) dispensed an opioid during the first trimester, 30,434 women (5.7%) during the second trimester, and 34,906 women (6.5%) during the third trimester. Of these, 11,747 women (2.2%) were dispensed opioids three or more times during pregnancy. The most commonly dispensed opioids during pregnancy were hydrocodone (6.8%), codeine (6.1%), and oxycodone (2.0%). The prevalence of exposure at anytime during pregnancy decreased slightly during the study period from 14.9% for pregnancies that delivered in 2005 to 12.9% in 2011. The prevalence of exposure varied significantly by region and was lowest in the Northeast and highest in the South.

Conclusions: This study demonstrates that opioids are very common exposures during pregnancy. Given the small and inconsistent body of literature on their safety in pregnancy, these findings suggest a need for research in this area.

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Conflict of interest statement

Conflicts of interest: SHD has consulted for Novartis, GlaxoSmithKlein-Biologics (Middlesex, England, United Kingdom) and AstraZenaca (London, England, United Kingdom) and JS is a consultant to Optum Insight (Eden Prairie, Minnesota, United States of America) and World Health Information Science Consultants, LLC (Newton, Massachusetts, United States of America), both for unrelated projects. The other authors declare no potential conflict of interest.

Figures

Figure 1
Figure 1. Among Patients Chronically Taking Opioids Prior to Pregnancy*, Patterns of Opioid Dispensing during (A) the First Trimester and (B) the Second Trimester. n=5,838
*Defined as patients who received 3 or more dispensings of an opioid pre-pregnancy (from −180 days to day prior to last menstrual period) during 3 separate months; analysis restricted to types of opioids with >100 pre-pregnancy chronic users
Figure 2
Figure 2
Temporal Trends in Opioid Dispensing During Pregnancy (overall) and by Trimester.
Figure 3
Figure 3
Temporal Trends in Opioid Dispensing During Pregnancy For the Four Most Commonly Prescribed Types.
Figure 4
Figure 4
Prevalence of Opioid Dispensing During Pregnancy (overall) by State.
See this image and copyright information in PMC

Comment in

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