Prevalence and duration of prescribed opioid use during pregnancy: a cohort study from the Quebec Pregnancy Cohort

Abstract

Background Recent studies show a rapid growth among pregnant women using high potency opioids for common pain management during their pregnancy. No study has examined the duration of treatment among strong opioid users and weak opioid users during pregnancy. We aimed to investigate the prevalence of prescribed opioid use during pregnancy, in Quebec; and to compare the duration of opioid treatment between strong opioid users and weak opioid users. Methods Using the Quebec Pregnancy Cohort (1998–2015), we included all pregnancies covered by the Quebec Public Prescription Drug Insurance Program. Opioid exposure was defined as filled at least one prescription for any opioid during pregnancy or before pregnancy but with a duration that overlapped the beginning of pregnancy. Prevalence of opioids use was calculated for all pregnancies, according to pregnancy outcome, trimester of exposure, and individual opioids. The duration of opioid use during pregnancy was analyzed according to 8 categories based on cumulative duration (< 90 days vs. ≥90 days), duration of action (short-acting vs. long-acting) and strength of the opioid (weak vs. strong). Results Of 442,079 eligible pregnancies, 20,921 (4.7%) were exposed to opioids. Among pregnancies ending with deliveries (n = 249,234), 5.4% were exposed to opioids; the prevalence increased by 40.3% from 3.9% in 1998 to 5.5% in 2015, more specifically a significant increase in the second and third trimesters of pregnancy. Weak opioid, codeine was the most commonly dispensed opioid (70% of all dispensed opioids), followed by strong opioid, hydromorphone (11%), morphine (10%), and oxycodone (5%). The prevalence of codeine use decreased by 47% from 4.3% in 2005 to 2.3% in 2015, accompanied by an increased use of strong opioid, morphine (0.029 to 1.41%), hydromorphone (0.115 to 1.08%) and oxycodone (0.022 to 0.44%), from 1998 to 2015. The average durations of opioid exposure were significantly longer among pregnancies exposed to strong opioid as compared to weak opioid regardless of the cumulative duration or duration of action (P < 0.05). Conclusions Given the differences in the safety profile between strong opioids and the major weak opioid codeine, the increased use of strong opioids during pregnancy with longer treatment duration raises public health concerns.

Gestational Buprenorphine Exposure Disrupts Dopamine Neuron Activity and Related Behaviors in Adulthood

“…The prevalence of opioid use during pregnancy is relatively similar across trimesters, suggesting that the timing and duration of exposure may have differential effects on the offspring ( Zhao et al, 2021 ). One caveat of studying prenatal opioid exposure in rodents is that the third trimester in humans corresponds to the first two weeks of postnatal life in rats ( Zeiss, 2021 ).…”

Anesthesia of a drug-addicted pregnant woman. The current state of knowledge

“…The review involved a meticulous examination of articles accessible through PubMed, published between January 2009 and December 2021, and conducted using the following keywords: 'pregnant,' 'addicted,' 'opioids,' 'NAS,' and 'withdrawal syndrome in obstetrics.' 1,2,4 The search encompassed relevant research from international sources as well as the Polish literature, considering articles available in Polish and English. 1,3 To ensure the inclusion of highquality research, particular attention was paid to the impact factor of the journals in which the articles were published.…”

“…Among pregnancies ending in delivery (249,234), 5.4% were exposed to opioids; the incidence of this phenomenon increased by 40.3% from 3.9% in 1998 to 5.5% in 2015, a significant increase was recorded in the 2nd and 3rd trimester of pregnancy. 4 A disturbing phenomenon was the rapid increase in the percentage of newborns with withdrawal syndrome. 2,3,5 As many as 2 out of 3 infants born with NAS were at risk of these complications because the mother used strong opioids during pregnancy.…”

Preconception care, prenatal care, and postpartum bonding in women with substance use

“…The Pregnancy Risk Assessment Monitoring System (PRAMS) estimated that 6.6% of pregnant women reported using prescription opioids [ 8 ]. The Quebec Pregnancy Cohort study from 1998 to 2015 showed that 4.7% of pregnant women were exposed to opioids [ 9 ]. Limited data are available on the prevalence of substance use among pregnant women in Iran.…”