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Am J Perinatol 2020; 37(14): 1467-1475
DOI: 10.1055/s-0039-1694725
Original Article

Opioid Use Disorder during Antepartum and Postpartum Hospitalizations

Adina R. Kern-Goldberger
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
,
Yongmei Huang
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
,
Melanie Polin
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
,
Zainab Siddiq
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
,
Jason D. Wright
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
,
Mary E. D'Alton
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
,
Alexander M. Friedman
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York
› Author Affiliations Funding A,M.F. is supported by a career development award (K08HD082287) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
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Abstract

Objective This study aimed to evaluate temporal trends in opioid use disorder (OUD) during antepartum and postpartum hospitalizations.

Study Design This repeated cross-sectional analysis analyzed data from the National (Nationwide) Inpatient Sample. Women aged 15 to 54 years admitted antepartum or postpartum were identified. The presence of OUD was determined based on a diagnosis of opioid abuse, opioid dependence, or opioid overdose. Temporal trends in OUD were evaluated using the Rao–Scott chi-square test. Temporal trends in opioid overdose were additionally evaluated.

Results An estimated 7,336,562 antepartum hospitalizations and 1,063,845 postpartum readmissions were included in this analysis. The presence of an OUD diagnosis during antepartum hospitalizations increased from 0.7% of patients in 1998 to 1999 to 2.9% in 2014 (p < 0.01) and during postpartum hospitalizations increased from 0.8% of patients in 1998 to 1999 to 2.1% of patients in 2014 (p < 0.01). Risk of overdose diagnoses increased significantly for both antepartum hospitalizations, from 22.7 per 100,000 hospitalizations in 1998 to 2000 to 70.3 per 100,000 hospitalizations in 2013 to 2014 (p < 0.001), and postpartum hospitalizations, from 18.8 per 100,000 hospitalizations in 1998 to 2000 to 65.2 per 100,000 hospitalizations in 2013 to 2014 (p = 0.02).

Discussion Risk of OUD diagnoses and overdoses increased over the study period for both antepartum and postpartum hospitalizations.

Keywords

opioid use disorder - pregnancy outcomes - opioid overdose - maternal risk

Note

This study was presented at the 2019 Society for Maternal-Fetal Medicine Pregnancy in Las Vegas, NV.


Supplementary Material



Publication History

Received: 28 May 2019

Accepted: 28 June 2019

Article published online:
17 August 2019

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA 2011; 305 (13) 1299-1301
    CrossrefPubMedGoogle Scholar
  • 2 Desai RJ, Hernandez-Diaz S, Bateman BT, Huybrechts KF. Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol 2014; 123 (05) 997-1002
    CrossrefPubMedGoogle Scholar
  • 3 Kuehn BM. Opioid prescriptions soar: increase in legitimate use as well as abuse. JAMA 2007; 297 (03) 249-251
    CrossrefPubMedGoogle Scholar
  • 4 Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths--United States, 2000-2014. Morb Mortal Wkly Rep 2016; 64 (50-51): 1378-1382
    CrossrefPubMedGoogle Scholar
  • 5 Bateman BT, Hernandez-Diaz S, Rathmell JP. et al. Patterns of opioid utilization in pregnancy in a large cohort of commercial insurance beneficiaries in the United States. Anesthesiology 2014; 120 (05) 1216-1224
    CrossrefPubMedGoogle Scholar
  • 6 Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology 2014; 121 (06) 1158-1165
    CrossrefPubMedGoogle Scholar
  • 7 Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder documented at delivery hospitalization - United States, 1999-2014. Morb Mortal Wkly Rep 2018; 67 (31) 845-849
    CrossrefPubMedGoogle Scholar
  • 8 Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol 2016; 215 (01) 113.e1-113.e10
    CrossrefPubMedGoogle Scholar
  • 9 ACOG Committee Opinion No. ACOG Committee Opinion No. 736: optimizing postpartum care. Obstet Gynecol 2018; 131 (05) e140-e150
    Google Scholar
  • 10 Healthcare Cost and Utilization Project. Overview of the National (Nationwide) Inpatient Sample (NIS). Accessed March 30, 2019 at: https://www.hcup-us.ahrq.gov/nisoverview.jsp
    Google Scholar
  • 11 White AG, Birnbaum HG, Mareva MN. et al. Direct costs of opioid abuse in an insured population in the United States. J Manag Care Pharm 2005; 11 (06) 469-479
    CrossrefPubMedGoogle Scholar
  • 12 Shei A, Rice JB, Kirson NY. et al. Characteristics of high-cost patients diagnosed with opioid abuse. J Manag Care Spec Pharm 2015; 21 (10) 902-912
    PubMedGoogle Scholar
  • 13 Centers for Disease Control and Prevention. Severe maternal morbidity in the United States. Accessed January 20, 2018 at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
    Google Scholar
  • 14 Kuklina EV, Whiteman MK, Hillis SD. et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12 (04) 469-477
    CrossrefPubMedGoogle Scholar
  • 15 Committee on Obstetric Practice. Committee Opinion No. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol 2017; 130 (02) e81-e94
    CrossrefPubMedGoogle Scholar
  • 16 Duffy CR, Wright JD, Landau R. et al. Trends and outcomes associated with using long-acting opioids during delivery hospitalizations. Obstet Gynecol 2018; 132 (04) 937-947
    CrossrefPubMedGoogle Scholar
  • 17 Schiff DM, Nielsen T, Terplan M. et al. Fatal and nonfatal overdose among pregnant and postpartum women in Massachusetts. Obstet Gynecol 2018; 132 (02) 466-474
    CrossrefPubMedGoogle Scholar