Opioid Use and Pregnancy Outcomes in Women With a Hypertensive Disorder of Pregnancy [31C]

Abstract

INTRODUCTION: Opioid use in pregnancy is increasing dramatically and is associated with poor maternal and neonatal outcomes. We sought to evaluate the relationship between opioid use and pregnancy outcomes among women with hypertensive disorders in pregnancy. METHODS: Retrospective cohort study among subjects with a hypertensive disorder of pregnancy that delivered ≥23 weeks gestation at a single institution (October '13-April '18). After IRB approval, subjects were stratified into two groups by opioid use (heroin, methadone or Subutex): current vs. non-users (never, quit prior to or during pregnancy). Differences were analyzed by Fisher's exact, t-test, and logistic regression, with α=0.05. RESULTS: From 10,833 deliveries, 1,487 (13.7%) were classified with a hypertensive disorder of pregnancy. 41 subjects (2.8%) actively used opioids during pregnancy, 1,098 (73.8%) were non-users and 348 (23.4%) were excluded due to unknown opioid use. Subjects using opioids were more likely to be covered by public insurance and using other substances. There were no differences in final hypertensive diagnosis for opioid users vs. non-users (p=0.26), although opioid users more often had severe diastolic blood pressure (≥110 mmHg) compared to non-users (p=0.012). Opioid use was associated with both adverse maternal and neonatal outcomes, which remained significant after adjustment for maternal characteristics and other substance use (aOR: 2.99, p=0.033 and aOR: 3.13, p=0.009, respectively). CONCLUSION: Among women with a hypertensive disorder of pregnancy, opioid use is associated with a 2-3 times increased odds for both adverse maternal and neonatal outcomes compared to non-users. These findings highlight the need to limit opioid use in pregnancy.

Postpartum management of hypertension and effect on readmission rates

“…We acknowledge limitations to this study include the biases implicit in retrospective study design. The initial cohort (24%) is large compared to rates of pHTN previously reported in the literature (11,12,13). Because of our method used to identify the study cohort, there is a risk of some patients being included that did not have pHTN and met criteria due to spurious blood pressure measurements.…”