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    Original Investigation
    Obstetrics and Gynecology
    July 29, 2020

    Association of Maternal Opioid Use in Pregnancy With Adverse Perinatal Outcomes in Ontario, Canada, From 2012 to 2018

    Author Affiliations
    • 1OMNI Research Group, Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
    • 2School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
    • 3Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
    • 4Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • 5Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
    JAMA Netw Open. 2020;3(7):e208256. doi:10.1001/jamanetworkopen.2020.8256
    Key Points español 中文 (chinese)

    Question  What are the trends in opioid use in pregnancy and is there an association between prenatal opioid use and perinatal outcomes?

    Findings  In this cohort study that included 804 346 births, 8059 women reported opioid use, and the rate of opioid use declined from 1.31% in 2012 to 2013 to 1.05% in 2017 to 2018. Use was higher among lower socioeconomic status groups and was associated with a 60% increase in risk of preterm birth before a gestational age of 37 weeks (14.0% among women with opioid use vs 6.0% in those with no use).

    Meaning  These findings suggest that opioid use in pregnancy is associated with higher rates of preterm birth and admission to neonatal intensive care after adjustment for confounding factors, and that rates of use have declined in recent years.


    Importance  A recent epidemic of opioid abuse has been described in many communities, although population-based data on trends in use in pregnancy and perinatal outcomes after in utero exposure remain limited.

    Objective  To assess trends in prenatal opioid use and the potential association between prenatal opioid use and preterm birth and adverse perinatal outcomes.

    Design, Setting, and Participants  This population-based retrospective cohort study covered live births and stillbirths among adolescents and women 15 years and older from April 1, 2012, to March 31, 2018, in Ontario, Canada. Data were analyzed from July 29 to October 15, 2019.

    Exposures  Any opioid use in pregnancy, ascertained through self-reporting and routine prenatal care.

    Main Outcome and Measures  The primary outcome was preterm birth before a gestational age of 37 weeks. Separate indicators for birth occurring at gestational ages of 34 to 36 weeks (plus 6 to 7 days; late preterm), 32 to 33 weeks (plus 6 to 7 days), 28 to 31 weeks (plus 6 to 7 days), and less than 28 weeks (very preterm birth). Secondary outcomes included small for gestational age, stillbirth, transfer to neonatal intensive care, and 5-minute Apgar score. Coarsened exact matching techniques and Poisson regression models were used to estimate the risk difference and relative risk (RR) of outcomes associated with cannabis exposure to control for confounding.

    Results  Among 710 911 women included in the analytic sample (mean [SD] age, 30.4 [5.3] years), 8059 used opioids (1.1%), with prevalence decreasing from 1.31% (95% CI, 1.25%-1.38%) in fiscal year 2012-2013 to 1.05% (95% CI, 0.99%-1.11%) in fiscal year 2017-2018 (P < .001 for trend). Use was highest among women in the lowest quintile of area-level income (2.36% vs 0.56% in the highest quintile; RR, 3.86; 95% CI, 3.58-4.15) and did not decrease over time in this group (from 2.63% [95% CI, 2.41%-2.87%] in 2012-2013 to 2.35% [95% CI, 2.14%-2.58%] in 2017-2018; P = .23 for trend). The crude rate of preterm birth at a gestational age of less than 37 weeks was 14.0% (n = 1127) among women with reported use in pregnancy and 6.0% (n = 42 226) among women who did not use opioids in the unmatched cohort. The adjusted RR for preterm birth before a gestational age of 37 weeks was 1.63 (95% CI, 1.52-1.75) among opioid users compared with nonusers and 1.77 (95% CI, 1.35-2.31) for preterm birth before 32 weeks. Among newborns, risk for neonatal intensive care was 40.5% with perinatal exposure to opioids compared with 13.9% in unexposed infants (RR, 2.91; 95% CI, 2.80-3.03).

    Conclusions and Relevance  Rates of opioid use in pregnancy have declined in recent years, although use remains significantly higher among lower-income women. In this large population-based cohort, opioid use in pregnancy was associated with an increased risk of preterm birth and admission to a neonatal intensive care unit.