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Opioid Drug Use and Acute Cardiac Events Among Pregnant Women in the United States

      Abstract

      Background

      Cardiovascular disease remains a leading cause of pregnancy-associated deaths in the United States. The extent to which increasing opioid use among pregnant women contributes to fatal cardiovascular events is unknown. We examined trends in opioid use among pregnant women over the previous decade and the association between changes in temporal trends in opioid drug use and the incidence of acute cardiac events among mothers.

      Methods

      In this retrospective analysis of the Healthcare and Cost Utilization Project, we used a 2-stage stratified cluster sampling of all inpatient hospital discharges from nonfederal hospitals from January 1, 2002 through December 31, 2014. The study population comprised pregnant women aged 13-49 years and related hospitalizations, including delivery. The primary exposure of interest was opioid use during pregnancy. The primary outcome was the occurrence of acute myocardial infarction or cardiac arrest during pregnancy or childbirth.

      Results

      Among the estimated 57.4 million pregnancy-related inpatient hospitalizations, 511,469 (approximately 1%) had documented use of opioids, cocaine, and/or amphetamines. There was a 300% increase in the use of opioids during pregnancy over the study period, whereas cocaine consumption significantly decreased and that of amphetamine remained stable. Over the 13-year period, the rise in opioid use paralleled a 50% increase in the incidence of acute cardiac events among mothers.

      Conclusion

      Over the previous decade opioid use during pregnancy increased significantly, in parallel with the rise in the incidence of acute cardiac events in pregnancy and childbirth. An effective national policy is needed to address this emerging public health challenge.

      Keywords

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      References

        • Darnall B.D.
        • Stacey B.R.
        Sex differences in long-term opioid use: cautionary notes for prescribing in women.
        Arch Intern Med. 2012; 172: 431-432
        • Epstein R.A.
        • Bobo W.V.
        • Martin P.R.
        • et al.
        Increasing pregnancy-related use of prescribed opioid analgesics.
        Ann Epidemiol. 2013; 23: 498-503
        • Whiteman V.E.
        • Salemi J.L.
        • Mogos M.F.
        • Cain M.A.
        • Aliyu M.H.
        • Salihu H.M.
        Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States.
        J Pregnancy. 2014; 2014: 906723-906728
        • Metz T.D.
        • Rovner P.
        • Hoffman M.C.
        • Allshouse A.A.
        • Beckwith K.M.
        • Binswanger I.A.
        Maternal deaths from suicide and overdose in Colorado, 2004-2012.
        Obstet Gynecol. 2016; 128: 1233-1240
        • Zagon I.S.
        • Tobias S.W.
        • Hytrek S.D.
        • McLaughlin P.J.
        Opioid receptor blockade throughout prenatal life confers long-term insensitivity to morphine and alters mu opioid receptors.
        Pharmacol Biochem Behav. 1998; 59: 201
        • Zagon I.S.
        • Verderame M.F.
        • Allen S.S.
        • McLaughlin P.J.
        Cloning, sequencing, expression and function of a cDNA encoding a receptor for the opioid growth factor, [Met(5)]enkephalin.
        Brain Res. 1999; 849: 147
        • Zagon I.S.
        • Verderame M.F.
        • McLaughlin P.J.
        The biology of the opioid growth factor receptor (OGFr).
        Brain Res Brain Res Rev. 2002; 38: 351-376
        • Zagon I.S.
        • Wu Y.
        • McLaughlin P.J.
        Opioid growth factor and organ development in rat and human embryos.
        Brain Res. 1999; 839: 313-322
        • McLaughlin P.J.
        • Zagon I.S.
        Body and organ development of young rats maternally exposed to methadone.
        Biol Neonate. 1980; 38: 185
        • McLaughlin P.J.
        Exposure to the opioid antagonist naltrexone throughout gestation alters postnatal heart development.
        Biol Neonate. 2002; 82: 207
        • McLaughlin P.J.
        • Wylie J.D.
        • Bloom G.
        • Griffith J.W.
        • Zagon I.S.
        Chronic exposure to the opioid growth factor, [Met 5]-enkephalin, during pregnancy: maternal and preweaning effects.
        Pharmacol Biochem Behav. 2002; 71: 171-181
      1. Dolphine [package insert].
        (Columbus, OH: Roxane Laboratories)2006
      2. Oxycontin [package insert].
        (Stamford, CT: Purdue Pharma)2010
        • American College of Obstetricians and Gynecologists
        • American Society of Addiction Medicine
        ACOG Committee Opinion No. 524: opioid abuse, dependence, and addiction in pregnancy.
        Obstet Gynecol. 2012; 119: 1070
        • American Academy of Pain Medicine
        Use of Opioids for the Treatment of Chronic Pain: A Statement from the American Academy of Pain Medicine.
        American Academy of Pain Medicine, Chicago2013
        • Broussard C.S.
        • Rasmussen S.A.
        • Reefhuis J.
        • et al.
        Maternal treatment with opioid analgesics and risk for birth defects.
        Am J Obstet Gynecol. 2011; 204 (e311): 314
        • Cohen E.
        • Horváth-Puhó E.
        • Ray J.G.
        • et al.
        Association between the birth of an infant with major congenital anomalies and subsequent risk of mortality in their mothers.
        JAMA. 2016; 316: 2515-2524
        • Hameed A.B.
        • Lawton E.S.
        • McCain C.L.
        • et al.
        Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy.
        Am J Obstet Gynecol. 2015; 213 (e371-310): 379
        • Gissler M.
        • Deneux-Tharaux C.
        • Alexander S.
        • et al.
        Pregnancy-related deaths in four regions of Europe and the United States in 1999-2000: characterisation of unreported deaths.
        Eur J Obstet Gynecol. 2007; 133: 179-185
        • MacDorman M.F.
        • Declercq E.
        • Cabral H.
        • Morton C.
        Recent increases in the U.S. maternal mortality rate: disentangling trends from measurement issues.
        Obstet Gynecol. 2016; 128: 447-455
        • Chen A.
        • Ashburn M.A.
        Cardiac effects of opioid therapy.
        Pain Med. 2015; 16: S27-S31
        • Carman W.J.
        • Su S.
        • Cook S.F.
        • Wurzelmann J.I.
        • McAfee A.
        Coronary heart disease outcomes among chronic opioid and cyclooxygenase-2 users compared with a general population cohort.
        Pharmacoepidemiol Drug Saf. 2011; 20: 754-762
        • Health Care Cost and Utilization Project
        Introduction to the HCUP Nationwide Inpatient Sample (NIS) 2011.
        Agency for Healthcare Research and Quality, Rockville, MD2013
        • Health Care Cost and Utilization Project
        Introduction to the HCUP Kids' Inpatient Database (KID) 2012.
        Agency for Healthcare Research and Quality, Rockville, MD2015
        • Health Care Cost and Utilization Project
        Elixhauser Comorbidity Software, Version 3.7.
        (Available at)
        • Elixhauser A.
        • Steiner C.
        • Harris D.R.
        • Coffey R.M.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Kim H.J.
        • Fay M.P.
        • Feuer E.J.
        • Midthune D.N.
        Permutation tests for joinpoint regression with applications to cancer rates.
        Stat Med. 2000; 19: 335-351
        • National Cancer Institute, Division of Cancer Control & Population Sciences, Surveillance Research Program
        Joinpoint Regression Program, Version 4.2.0.2.
        (Available at)
        http://surveillance.cancer.gov/joinpoint/
        Date accessed: January 4, 2015
        • Houchens R.L.
        • Ross D.
        • Elixhauser A.
        Using the HCUP National Inpatient Sample to Estimate Trends.
        (HCUP Methods Series Report #2006-05 ONLINE. January 4, 2016. U.S. Agency for Healthcare Research and Quality; Available at:) (Accessed May 15, 2017)
        • Scott A.J.
        • Dunlop A.J.
        • Brown A.
        • Sadler C.
        • Isbister G.K.
        The prevalence of QT prolongation in a population of patients with substance use disorders: QT prolongation in substance use disorder patients.
        Drug Alcohol Rev. 2017; 36: 239-244
        • Badui E.
        • Enciso R.
        Acute myocardial infarction during pregnancy and puerperium: a review.
        Angiology. 1996; 47: 739-756
        • Pacheco L.D.
        • Saade G.R.
        • Hankins G.D.V.
        Acute myocardial infarction during pregnancy.
        Clin Obstet Gynecol. 2014; 57: 835-843
        • Mogos M.F.
        • Salemi J.L.
        • Spooner K.K.
        • McFarlin B.L.
        • Salihu H.M.
        Differences in mortality between pregnant and nonpregnant women after cardiopulmonary resuscitation.
        Obstet Gynecol. 2016; 128: 880-888
        • Mhyre J.M.
        • Tsen L.C.
        • Einav S.
        • Kuklina E.V.
        • Leffert L.R.
        • Bateman B.T.
        Cardiac arrest during hospitalization for delivery in the United States, 1998-2011.
        Anesthesiology. 2014; 120: 810-818
        • Quan H.
        • Li B.
        • Saunders L.D.
        • et al.
        Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database.
        Health Serv Res. 2008; 43: 1424-1441