(790) Opioid Use in Pregnancy Adversely Affects Perinatal Outcomes

Perinatal opioid use affects almost 4 million pregnancies annually and has become a leading cause of maternal mortality. Studies on prenatal opioid use are limited by varying methodology, inconsistently controlling for confounders, and focusing on a narrow scope of outcomes. Existing population-based data is largely from outside the United States (US) with different demographics. The objective of this study is to examine US-based population-level associations between perinatal opioid use, and maternal and neonatal outcomes.

Study Design:

This is a secondary data analysis using California linked vital statistics and hospital discharge data from 2008-2019. We included singleton, live-born infants with gestational age of 23-42 weeks. Opioid-related diagnosis during pregnancy was identified using ICD-9 and ICD-10 codes from hospital discharge data. Chi-squared and multivariable logistic regression were utilized for statistical analyses.

Results:

A total of 5,470,747 pregnancies met inclusion criteria, and 13,026 (0.24%) had opioid-related diagnosis. Opioid use was associated with higher risk of hypertensive disorders (aOR 1.57; 95% CI: 1.48-1.67), severe maternal morbidity (aOR 2.36; 95% CI: 2.14-2.62), blood transfusion (aOR=2.29, 95% CI: 2.06-2.56)), venous thromboembolism (aOR 2.34; 95% CI: 2.09-2.62), and primary cesarean delivery (aOR 1.21; 95% CI: 1.13-1.29). Neonates exposed to in utero opioids had higher risks of neonatal intensive care unit admission (aOR 5.08; 95% CI: 4.89-5.29), respiratory distress syndrome (aOR 2.24; 95% CI: 2.09-2.39), neonatal opioid withdrawal syndrome (aOR 137.1; 95% CI 129.1-145.7), small for gestational age (aOR 1.71; 95% CI: 1.62-1.79), and infant death (aOR 1.51; 95% CI 1.23-1.85).

Conclusion: Our study suggests that a prenatal opioid-related diagnosis is associated with a significantly increased risk of maternal and neonatal morbidity. As the perinatal opioid crisis persists, our findings can help inform patient care and counseling.