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CDC: Opioid Painkillers Widely Prescribed Among Reproductive-Age Women

Opioid exposure during pregnancy increases risk of birth defects

More than a third of reproductive-aged women enrolled in Medicaid, and more than a quarter of those with private insurance, filled a prescription for an opioid pain medication each year during 2008–2012, according to data in this week’s Morbidity and Mortality Weekly Report.

Opioids are typically prescribed by health care providers to treat moderate-to-severe pain. They are also found in some prescription cough medications. The most commonly prescribed opioids among both groups of women were hydrocodone, codeine, and oxycodone.

“Taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother,” said CDC Director Tom Frieden, MD, MPH. “Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child. That’s why it’s critical for health care professionals to take a thorough health assessment before prescribing these medicines to women of reproductive age.”

CDC researchers analyzed 2008–2012 data from two large health insurance claims datasets: one of women aged 15 to 44 years with private insurance, and another of women in the same age group enrolled in Medicaid. The investigators found that, on average, 39% of Medicaid-enrolled women filled an opioid prescription from an outpatient pharmacy each year compared with 28% of women with private health insurance.

The higher opioid prescribing rates among Medicaid enrollees might be due to differences in the prescription medications covered under their health insurance plan, differences in their use of health care services, or differences in the prevalence of underlying health conditions among Medicaid enrollees compared with persons covered by private health insurance, the CDC says.

Geographic-region data available in the private insurance claims indicated that opioid prescription rates were highest among reproductive-aged women in the South and lowest in the Northeast. Race/ethnicity information was available for the Medicaid data and indicated that opioid prescriptions were nearly one and a half times higher among non-Hispanic white women of reproductive age compared with non-Hispanic black or Hispanic women.

Previous studies of opioid use in pregnancy suggested that these medications might increase the risk of neural tube defects (major defects of the baby’s brain and spine), congenital heart defects, and gastroschisis (a defect of the baby’s abdominal wall). There is also a risk of neonatal abstinence syndrome (NAS) from exposure to medications such as opioids in pregnancy. NAS is when a newborn experiences symptoms of withdrawal from medications or drugs taken by a mother during pregnancy.

“Women who are pregnant or are planning to become pregnant should discuss with their health care professional the risks and benefits for any medication they are taking or considering,” said Coleen Boyle, PhD, MSHyg, Director of the CDC’s National Center on Birth Defects and Developmental Disabilities. “This new information underscores the importance of responsible prescribing, especially of opioids, for women of child-bearing age.”

Source: CDC; January 22, 2015.

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