Prescribed opioid analgesics in early pregnancy and the risk of congenital anomalies: a population-based cohort study

Abstract

Study design and data sourcesWe constructed a populationbased cohort of deliveries using administrative health data of the singlepayer health care system in Ontario, Canada, held at ICES. We identified parent-infant pair

Safety of prenatal opioid analgesics: Do results differ between public health insurance beneficiary and population‐based cohorts?

“…First trimester opioid analgesic exposure also was higher in U.S. Medicaid (4.4%) than commercially insured births (1.1%) (Bateman et al, 2021). Common medications in the beneficiary cohort were codeine and oxycodone, similar to the population‐based cohort (Bowie et al, 2022); oxycodone and hydromorphone were prevalent in U.S. deliveries (Bateman et al, 2021). Comorbidities were higher in the beneficiary cohort than the Ontario population‐based cohort (Bowie et al, 2022), and a greater proportion of the beneficiary cohort had psychotropics dispensed in pregnancy and opioid analgesics dispensed in the year before pregnancy.…”

“…Common medications in the beneficiary cohort were codeine and oxycodone, similar to the population‐based cohort (Bowie et al, 2022); oxycodone and hydromorphone were prevalent in U.S. deliveries (Bateman et al, 2021). Comorbidities were higher in the beneficiary cohort than the Ontario population‐based cohort (Bowie et al, 2022), and a greater proportion of the beneficiary cohort had psychotropics dispensed in pregnancy and opioid analgesics dispensed in the year before pregnancy. The beneficiary cohort was younger, and a greater proportion was in the lowest socioeconomic quintile and fewer in the highest.…”

“…First trimester opioid analgesic exposure was 7.9% in beneficiary deliveries in 1996–2018 and 2% in Ontario population‐based deliveries in 2013–2018 (Bowie et al, 2022); morphine equivalent dose was higher in beneficiaries. First trimester opioid analgesic exposure also was higher in U.S. Medicaid (4.4%) than commercially insured births (1.1%) (Bateman et al, 2021).…”

“…We followed the methods of an Ontario population‐based cohort of singleton deliveries ( N = 599,579) to women without opioid use disorder from 2013 to 2018, 2% of whom were exposed to opioid analgesics (Bowie et al, 2022). The same exposure, outcome, and analysis methods of this population‐based cohort were used in the present study to construct a cohort of deliveries to Ontario Drug Benefit (ODB) beneficiaries.…”

“…Although type of health insurance itself would not have a biologic effect on opioid analgesic–anomaly associations, demographic and medical characteristics of pregnancies with particular insurance coverage could. We therefore sought to study whether the increased risk of congenital anomalies after opioid analgesics observed in a population‐based cohort recently published (Bowie et al, 2022) differed in low‐income prescription beneficiaries.…”