National trends in maternal use of opioid drugs during pregnancy

Background: Maternal use of opioid drugs during pregnancy is associated with multiple maternal and neonatal adverse outcomes. Understanding the national prevalence and trend of the problem is critical. Method: Using the Nationwide Inpatient Sample (NIS: 1998-2009), we identified hospital discharge records associated with the diagnoses codes for the use of opioids using the International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) codes. Opioid use related hospitalizations among pregnancy related admissions by region, gender, hospital setting, payer source, and hospital location were calculated per 1000 deliveries. Joinpoint regression modeling was used to describe annual percent changes (APC) in trend of pregnancy-related opioid use. Results: A total of 138,224 cases of opioids use during pregnancy occurred for over 55,781,966 hospitalizations during the study period, presenting a prevalence of 2.48 (CI:2.18,2.78) per 1000 deliveries. The trend in opioid use significantly decreased from 1998-2001(APC=-14.1[CI:-26.1,-0.2]) followed by significant increment from 2001 to 2009 (APC=11.9[CI:8.9,15.0]). The trend varied by region with higher APC in the North East region (APC=12.17, [CI:7.34,17.22]) and lowest in the West region (APC=6.67, [CI:2.35,11.18]). The mean prevalence of opioid use among diverse age groups showed an inverse relationship with maternal age, with higher mean prevalence among older mothers (≥35 years, 0.28%) and lower among young mothers (<20 years, 0.09%). Conclusion: Our findings point to the need to revise prescription guidelines, practices, and regulatory mechanisms. It is critical that health care providers weight the benefits of these medications along with their potential risks when discussing analgesic treatment options with pregnant women.