Opioid Use Disorder on the Rise in Pregnant Women

A look at what expectant moms can do to counteract this critical increase

with Theresa Mallick-Searle, RN-BC, ANP-BC

Rates of opioid use disorder (OUD) in pregnant women have quadrupled between 1999 and 2014, according to a report published by the US Centers for Disease Control and Prevention (CDC). Exposure to opioids during pregnancy increases the risk of complications for both mom and baby, including preterm labor, stillbirth, neonatal abstinence syndrome (withdrawal symptoms a newborn may experience after birth), and maternal mortality.

“This report identifies a significant public health issue,” explains Theresa Mallick-Searle, RN-BC, ANP-BC, who works in the division of pain medicine at Stanford Health Care in California. “It [also] highlights the importance of screening, monitoring, and management of opioid use disorder during pregnancy.”

Opioid use disorder (OUD), also referred to as opioid addiction, is a pattern of opioid use characterized by tolerance, craving, inability to control use, and continued use despite adverse consequences. OUD is a chronic, treatable disease that can be managed successfully by combining medications with behavioral therapy and recovery support, which helps regain a patient’s control of their health and their lives, according to the American College of Obstetricians and Gynecologists.

Opioids and PregnancyThe CDC has reported increasing rates of Opioid Use Disorder in pregnant women. (Source: 123RF)

What’s Behind the Increase?

As part of the CDC report, Sarah C. Haight, MPH, and colleagues documented the presence of OUD in obstetric patients at in-hospital deliveries. Data was available from a total of 30 states, as well as Washington, DC; only 14 states were analyzed during 1999, whereas 28 states were analyzed during 2014.

According to the analysis, the national prevalence of OUD increased by 333%. In 1999, 1.5 cases of OUD per 1,000 in-hospital deliveries were documented, compared to 6.5 per 1,000 in 2014. The national average annual rate of increase was 0.4 cases per 1,000 in-hospital deliveries per year.

Statewide analyses revealed OUD prevalence ranging from 0.7 in Washington, DC to 48.6 in Vermont during 1999. By 2014, more than 30 cases per 1,000 in-hospital deliveries were documented in states such as Vermont and West Virginia. Average annual rates increased linearly across all states over the span of the study. California reflected the lowest increase in annual rate, whereas Maine, New Mexico, Vermont, and West Virginia had the highest increases in average annual rates. These rates ranged from 2.5 to 5.4 cases per 1,000 in-hospital deliveries per year.

According to the report, trends of increased average annual rates may have resulted in part from better screening and diagnostic practices over time, rather than a higher prevalence of OUD. However, there remains a “continued need for national, state, and provider efforts to prevent, monitor, and treat opioid use disorder among reproductive-aged and pregnant women,” wrote the CDC authors.

What Options are Available?

Mallick-Searle says there is much to consider, including whether a woman is using opioids during pregnancy to manage a pre-existing or worsening chronic pain condition, and whether she has an OUD diagnosis. Women without an OUD who use opioids responsibly during pregnancy under the care of their clinician should be allowed to do so without scrutiny, she notes.

Mallick-Searle further recommends that women who struggle with an existing substance abuse disorder, who are either currently pregnant or contemplating a future pregnancy, should feel empowered to openly discuss these issues with their clinician or social worker. There are many community services available to assist with family planning, education, and guidance focused on a healthy pregnancy. The US Substance Abuse and Mental Health Services Administration (SAMSHA) offers a list of resources at the regional level. 

Updated on: 11/19/18
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