Opioids and Psychotropic Medication Frequently Coprescribed During Pregnancy

Opioids coprescribed with psychotropic medications during pregnancy increase antepartum hospitalization risk, according to a study in the Annals of Internal Medicine. Additionally, many women who are prescribed opioids receive doses that increase the risk for overdose.

Investigators conducted a cross-sectional study analyzing US commercial insurance beneficiary data obtained from MarketScan between 2001 and 2015. Data were obtained for pregnant women who were at 22 weeks’ gestation or more and who were insured continuously for 3 months or more prior to pregnancy and through delivery.

The main outcomes included the opioid prescription rate, dosage thresholds, number of opioid agents prescribed, and duration of opioid use (≥30 days) among women with and without psychotropic prescriptions. Dosage thresholds were defined as clinically significant CDC thresholds, including morphine milligram equivalents (MME) of 50 or higher and 90 or more per day.

A total of 958,980 women who were pregnant were included in this analysis. Overall, 10% of these women received a prescription for opioids only, 6% had a prescription for psychotropic medications only, and 2% were treated with a coprescription of opioids and psychotropics. Prescriptions for opioids were highest in women who were prescribed psychotropics compared with women not prescribed psychotropics (26.5% vs 10.7%, respectively).

During the study timeframe, there was a decrease in the number of women prescribed opioids but not psychotropics (11.9% to 8.4% from 2001 to 2015), while there was an overall increase in psychotropic prescription rate during this same time (4.4% to 7.6%). Opioid prescriptions with a coprescription of psychotropics decreased from 28.1% to 22%.

MME of 50 or higher per day decreased for women with and without a prescription for a psychotropic agent (29.6% to 17.3% and 22.8% to 18.5%, respectively). The MME of 90 or higher per day also decreased in women with and without a coprescription (15% to 4.7% and 11.5% to 4.2%, respectively).

Antepartum hospitalization was more likely in women who received an opioid prescription only compared with women who didn’t receive a prescription (1 admission: adjusted risk ratio [aRR], 2.64; 95% CI, 2.56-2.72; ≥2 admissions: aRR, 3.65; 95% CI, 3.43-3.88). Additionally, women with a coprescription of opioids and psychotropics had a higher rate of antepartum hospitalization compared with women prescribed only psychotropics (1 admission: aRR, 1.81; 95% CI, 1.73-1.90; ≥2 admissions: aRR, 2.27; 95% CI, 2.09-2.47).

Women who received a coprescription were also more likely to exceed an MME of 90 or higher per day compared with those prescribed only opioids. These women were also more likely to receive a prescription for 2 or more opioid agents and a prescription lasting 30 or more days. According to the researchers, the number of opioids and duration of opioid use increased with a coprescription with gabapentin and benzodiazepine.

The study was limited by its inability to capture overdose events, as many of these events did not always occur at the hospital.

“Judicious evidence-based opioid and psychotropic prescribing in pregnancy and further research to understand indications for using these medications in an era of increasing concern about opioid misuse are needed,” the researchers concluded, “which could have a significant impact on maternal and infant outcomes.”

Reference

Venkatesh KK, Pate V, Boggess KA, Jones HE, Funk MJ, Smid MC. Trends in opioid and psychotropic prescription in pregnancy in the United States from 2001 to 2015 in a privately insured population: a cross-sectional study. Ann Intern Med. 2020;173(11_Supplement):S19-S28. doi: 10.7326/M19-3249