Magazine article Clinical Psychiatry News

Prescription Opioids: Is There a Risk for Birth Defects?

Magazine article Clinical Psychiatry News

Prescription Opioids: Is There a Risk for Birth Defects?

Article excerpt

Concerns have been raised about the widespread use of opioid analgesics in the general population, and specifically among pregnant women.

In women of reproductive age, U.S. claims data for the years 2008-2012 indicate that 39.4% of Medicaid-enrolled women and 27.7% of privately insured women had at least one opioid analgesic prescription claim. (1) Among pregnant women, approximately 4.4% reported use of opioid analgesics any time in the month before and throughout gestation in a sample of 11,724 control mothers who participated in the National Birth Defects Prevention Study (NBDPS) 1998-2011. (2)

Previous studies of first-trimester exposure to opioid analgesics have shown inconsistent associations with selected major congenital anomalies. A 2011 analysis of 1,693 first-trimester codeine-exposed pregnancies enrolled in the Norwegian Mother and Child Cohort Study found no evidence of an increased risk of major birth defects overall (odds ratio, 0.8; 95% confidence interval, 0.51.1), compared with 65,316 unexposed pregnancies. This study had insufficient power to examine modest associations with most specific major birth defects. (3)

In contrast, two recent case-control studies have showed significantly increased risks for early pregnancy opioid analgesic use and specific defects.

Broussard et al. (2011) used data from the NBDPS 1997-2005 to test hypotheses related to specific defect associations previously reported in the literature, as well as to explore associations with additional defects. Therapeutic opioid use in early pregnancy was reported by 2.6% of 17,449 case mothers and 2.0% of 6,701 control mothers. The authors confirmed associations with some specific heart defects, and spina bifida, with ORs ranging from 2.0 to 2.7. In exploratory analysis, gastroschisis also was significantly associated with opioid analgesic exposure in early pregnancy (OR, 1.8; 95% Cl, 1.12.9). Although additional analyses were performed stratified by specific opioid product (codeine, hydrocodone, oxycodone, meperidine), as might be expected, the most commonly used products (codeine and hydrocodone) were linked to a greater number of elevated ORs for specific defects. (4)

In the second case-control study, Yazdy et al. (2013) used data collected in four cities in the United States and Canada and from two birth defect registries between 1998 and 2010 to examine periconceptional opioid use and risk for neural tube defects. The adjusted OR for spina bifida, comparing mothers of malformed infants with mothers of nonmalformed infants, was 2. …

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