Increased Risk for Opioid-Related Disorders in Pregnant Women With Sickle Cell Disease

The risk for opioid-related disorders (ORD) is significantly increased among pregnant women with vs without sickle cell disease (SCD), according to study results published in Pain Medicine.

Studies have reported a 5-fold increase in maternal opioid use in the United States over the last 2 decades. Opioids are frequently used for pain relief and can be used in the management of SCD; however, opioid use can have adverse effects on pregnancy outcomes.                                                                                                                                                                                                                                                                                                                                                                                                      

The objective of the current study was to investigate trends in ORD among pregnant women with and without SCD. Researchers compared several maternal-fetal outcomes, including preterm labor, maternal sepsis, and poor fetal growth, between women with and without ORD, based on SCD status. The definition of ORD included indications of opioid type dependence, nondependent opioid abuse, poisoning by opioids and opiates, and adverse effects of opioids in therapeutic use. The primary study outcome was risk for ORD among pregnant women with SCD and its effect on preterm labor, fetal growth, and maternal sepsis.

The retrospective study included pregnant women aged between 15 and 49 years from the Nationwide Inpatient Sample, covering hospitalizations in the United States between January 1, 2002, and December 31, 2014.

In the nationally representative analysis of >57 million pregnancy-related hospitalizations, a total of 54,884 women were previously diagnosed with SCD (prevalence of 9.6 per 10,000). Although there was an increase in the prevalence of ORD during the study period among both women with and without SCD, the increase was significantly greater among those without SCD.

The prevalence of ORD was 0.5% (257,550 women) in the general population and 2% (1040 women) among mothers with SCD, indicating a 4-fold increased risk for ORD in women with SCD. Over the study period, the prevalence of ORD was nearly 4 times as high among pregnant women with vs without SCD (18.94 vs 4.48 per 1000).

Compared with pregnant women without SCD and without a diagnosis of ORD, those with SCD and ORD had a nearly 9-fold increased risk for maternal sepsis (adjusted odds ratio [aOR], 8.83; 95% CI, 3.32-23.48). However, the risk for threatened preterm labor or poor fetal growth was not statistically significant. Compared with pregnant women without both SCD and ORD, pregnant women without SCD with ORD had significantly higher risk for maternal sepsis (aOR, 4.05; 95% CI, 3.56-4.62), threatened preterm labor (aOR, 1.08; 95% CI, 1.00-1.15), and poor fetal growth (aOR, 2.75; 95% CI, 2.60-2.92).

Study limitations included those secondary to analyses of hospital discharge data, without the possibility to collect additional relevant information, potential errors of misclassification, and the inability to assess the doses of the opioids used or identify hospitalizations with treated or untreated opioid-related diagnoses.

“These findings underscore the need for a targeted public health intervention at multiple levels (individual, family, community, provider interface, and policy making) and additional research on nonopioid treatment of pain in SCD, including in pregnancy, to increase our understanding of best practices to foster healthy pregnancies and more positive health outcomes for women with SCD,” the researchers concluded.

Reference

Darlington F, Acha BM, Roshan T, et al. Opioid-related disorders among pregnant women with sickle cell disease and adverse pregnancy outcomes. Published online July 25, 2020. Pain Med. doi:10.1093/pm/pnaa188