CDC Articles and Key Findings About Opioid Use During Pregnancy
Below are selected key findings and articles of interest published by CDC authors.
Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the United States, 2010–2017
This study examined the trends in maternal opioid-related diagnoses (including opioid use disorder, long-term opioid use, and unspecified opioid use) and neonatal abstinence syndrome in hospital discharge records among 47 states and the District of Columbia from 2010 through 2017. Findings reveal that the rates of women with opioid-related diagnosis at delivery and of babies born with withdrawal symptoms increased from 2010–2017. Specifically, mothers with opioid-related diagnoses documented at delivery increased by 131%. The incidence of babies born with NAS increased by 82% nationally over the same period. Increases were seen for nearly all states and demographic groups. These findings highlight the importance of state-level strategies to improve screening for and access to treatment of opioid use disorder for pregnant and postpartum women, including quality improvement for those who are impacted.
Read the full scientific articleexternal icon.
Identification of Substance-Exposed Newborns and Neonatal Abstinence Syndrome Using ICD-10-CM, 15 Hospitals, Massachusetts, 2017
In this Morbidity and Mortality Weekly Report, CDC evaluated how well International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes can be used for estimating the prevalence of substance-exposed newborns and neonatal abstinence syndrome (NAS) in Massachusetts. ICD-10-CM codes correctly identified a higher proportion of infants that truly had NAS than the ICD-10-CM codes used to identify substance-exposed newborns. These data validate the use of ICD-10-CM codes for identification of infants with neonatal abstinence syndrome and demonstrate opportunities for improvement of the identification of substance-exposed newborns.
Read the full scientific article.
Prescription Opioid Pain Reliever Use During Pregnancy — 34 U.S. Jurisdictions, 2019
In this Morbidity and Mortality Weekly Report, CDC documented population-based, self-reported estimates of prescription opioid pain reliever use during pregnancy using the Pregnancy Risk Assessment Monitoring System (PRAMS) and two additional maternal and infant health surveys. They found that approximately 7% of women reported using prescription opioids during pregnancy. Of those, 1 in 5 reported misuse of prescription opioids, defined by this survey as getting them from a non-healthcare source or using them for a reason other than to relieve pain. Ensuring the appropriate use of prescription opioids among pregnant women can help improve the health of both mothers and their babies.
Identifying Babies Born Exposed to Opioids and Gabapentin Can Improve Treatment
A study by Marshall University, in collaboration with CDC, found that identifying babies exposed to opioids and gabapentin in the womb may result in better treatment and shorter hospital stays. Opioids are medicines used to treat some types of pain or to treat opioid use disorder. Healthcare providers should closely watch pregnant women who use opioids to carefully manage the medical care for both mother and baby during pregnancy and after delivery. One of the concerns is withdrawal symptoms in the newborn.
Gastroschisis Trends and Ecological Link to Opioid Prescription Rates in the United States, 2006–2015
Gastroschisis is a birth defect of the abdominal (belly) wall. Several studies show increased rates of babies born with gastroschisis over time. Most of these babies are born to young mothers. A study from CDC found that the number of babies born with gastroschisis was higher in U.S. counties with high opioid (pain medicine) prescription rates, compared to those with low opioid prescription rates.
- Researchers estimated that in 20 U.S. states, from 2006–2015, about 1 in every 2,300 babies was born with gastroschisis.
- This study looked at reported cases of gastroschisis by county in 20 U.S. states and found that counties where doctors frequently prescribe opioids had 1.6 times more babies born with gastroschisis compared to counties with low opioid prescription rates.
- Researchers aren’t currently able to explain why gastroschisis rates are more common in these counties. More research is needed to understand what factors may contribute to this observed association.
Tracking rates of birth defects and opioid prescriptions are key to understanding how mothers and babies may be impacted by the opioid crisis.
Public Health Reporting of NAS Offers Opportunities for Treatment and Prevention
A CDC article looked at the laws enacted in six states requiring health departments or hospitals to report all babies born with neonatal abstinence syndrome (NAS) for public health monitoring.
- State officials noted that required reporting of infants born with NAS has helped their state
- Estimate the number of babies born with NAS in real-time;
- Locate specific areas more severely impacted by NAS to help target resources; and
- Identify mothers and babies affected by opioid use disorder who may benefit from local programs and services.
- States that require hospitals to report NAS cases may need additional resources and training for healthcare providers and hospital staff. This can help ensure that high-quality information is collected.
- This report found that states use different criteria and approaches for public health reporting of NAS. States considering implementation of laws requiring NAS case reporting for public health surveillance can benefit from understanding the advantages and challenges of the approaches used.
Read the full scientific article.
Opioids Prescribed Just Before Pregnancy Associated with Autism
A study from the Waisman Center at the University of Wisconsin-Madison, in collaboration with CDC, found that mothers who were prescribed opioids just before becoming pregnant were more likely to have a child with autism spectrum disorder (ASD) or a child with other developmental disabilities (DDs) and some autism symptoms.
- Mothers who were prescribed opioids just before becoming pregnant (1.2% of mothers with a child in the ASD group) were about 2.5 times more likely to have a child with ASD or a child with other DDs and some autism symptoms.
- In this study, about 8% of mothers reported receiving an opioid prescription just before or during pregnancy. The majority (76%) of these mothers received only one prescription. The most common reasons for opioid prescriptions were migraine headaches, injury, and back pain. Illicit opioid use was not included in this analysis.
This study is among the first to assess associations between prescription of opioids in pregnancy and ASD and other DDs. Researchers were limited by small sample sizes and were not able to assess whether the associations found were related to the opioid medication itself, to the reason the mother took the medication, or to some other unknown factor associated with opioid use. More research is needed to better understand developmental outcomes among children whose mothers used opioids during pregnancy.
Read the scientific summaryexternal icon.
Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999–2014
The number of pregnant women with opioid use disorder (OUD) at labor and delivery more than quadrupled from 1999 to 2014, according to an analysis by CDC. This first-ever, multi-state analysis of trends, published in CDC’s Morbidity and Mortality Weekly Report, reveals significant increases in the 28 states with available data.
- The national prevalence rate of OUD among pregnant women increased from 1.5 per 1,000 delivery hospitalizations in 1999 to 6.5 in 2014. On average, the national prevalence rate grew by 0.39 cases per 1,000 each year.
- From 1999–2014, the average annual rate increases were lowest in California and Hawaii (growth of less than 0.1 cases per 1,000 each year) and highest in Maine, New Mexico, Vermont, and West Virginia (all with an increase of more than 2.5 cases per 1,000 each year).
Read the full scientific article.
Educational Disabilities Among Children Born with Neonatal Abstinence Syndrome
In this study, published in Pediatrics, the Tennessee Department of Health, supported by CDC and March of Dimes, looked at longer-term educational outcomes among children born with NAS in the United States by linking Tennessee Medicaid data with birth certificate and state educational data. Researchers found that children born with NAS were more likely than children without NAS to be evaluated for an educational disability, to be diagnosed with a developmental delay or speech/language impairment, and to have received classroom support or speech therapy.
Maternal Use of Opioids during Pregnancy and Congenital Malformations: A Systemic Review
In this report, published in Pediatrics, CDC researchers reviewed previous studies to better understand what is currently known about opioids use during pregnancy and birth defects.
Specifically, the reviewexternal icon found:
- Use of opioids during pregnancy may be linked to various birth defects such as oral clefts, congenital heart defects, and clubfootexternal icon.
- Many of the studies reviewed; however, had issues with study methods and quality.
More research is needed to understand the connections between opioid use during pregnancy and specific birth defects. Until more is known, women of childbearing age considering opioid treatment should discuss the risks and benefits with their healthcare providers.
Read the scientific abstractexternal icon.
Incidence of Neonatal Abstinence Syndrome — 28 States, 1999–2013
In this Morbidity and Mortality Weekly Report, CDC analyzed neonatal abstinence syndrome (NAS) trends in 28 states using hospital discharge data from 1999 through 2013 and found the rate of NAS had increased 300%.
- From 1999 through 2013, the rate of NAS increased from 1.5 per 1,000 hospital births in 1999 to 6.0 cases per 1,000 hospital births. In 2013, more than 8,000 newborns were born with NAS, compared to about 2,000 newborns in 1999.
- In 2013, there was considerable variation in NAS incidence rates by state, ranging from 0.7 (Hawaii) to 33.4 (West Virginia) cases per 1,000 hospital births.
Read the full scientific article.
CDC Grand Rounds: Public Health Strategies to Prevent Neonatal Abstinence Syndrome
In this Morbidity and Mortality Weekly Report, CDC reports on public health strategies to prevent NAS outlined in a recent Public Health Grand Rounds presentation.
- Ensuring appropriate opioid prescribing that’s in line with the “CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016.”
- Maximizing and enhancing prescription drug monitoring programs pdf icon[PDF – 7.89 MB], state-based databases that collect, monitor, and analyze controlled substance dispensing.
- Increased access to preconception health care and quality family planning services.
Read the full scientific article.
Opioid Prescription Claims among Women of Reproductive Age — United States, 2008–2012
In 2015, CDC’s Morbidity and Mortality Weekly Report published a study looking at how often women aged 15–44 years filled a prescription for opioid pain medications.
- During 2008–2012, more than one-quarter of privately insured and over one-third of Medicaid-enrolled women aged 15–44 years filled a prescription written by a healthcare provider for an opioid medication.
- The most commonly prescribed opioids were hydrocodone, codeine, and oxycodone.
- A Field Placement Approach to Enhance State and Local Capacity for Opioid-Related Issues Affecting Pregnant and Postpartum People and Infants Prenatally Exposed to Opioids and Other Substancesexternal icon
Weber MK, Tran EL, Kroelinger CD, et al. J Women’s Health. 2022; 31(2):145–153.
- The MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment of Opioid Use Disorder During Pregnancy (MAT-LINK): Surveillance Opportunityexternal icon
Tran EL, Kim SY, England LJ, et al. J Women’s Health. 2020; 29(12):1491–1499.
- Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy—34 U.S. Jurisdictions, 2019.
Ko JY, D’Angelo DV, Haight SC, et al. MMWR Morb Mortal Wkly Rep. 2020;69(28);897–903.
- Neonatal Abstinence Syndrome Incidence and Health Care Costs in the United States, 2016.external icon
Strahan AE, Guy GP, Bohm M, et al. (2019). JAMA Pediatrics 2019;174(2):200–202.
- National Trends in Hepatitis C Infection by Opioid Use Disorder Status Among Pregnant Women at Delivery Hospitalization—United States, 2000–2015
Ko JY, Haight SC, Schillie SF, Bohm MK, Dietz PM. MMWR Morb Mortal Wkly Rep. 2019;68:833–838.
- State Strategies to Address Opioid Use Disorder Among Pregnant and Postpartum Women and Infants Prenatally Exposed to Substances, Including Infants with Neonatal Abstinence Syndrome.
Kroelinger CD, Rice ME, Cox S, et al. MMWR Morb Mortal Wkly Rep. 2019;68:777–783.
- Obstetrician–Gynecologists’ Practice Patterns Related to Opioid Use During Pregnancy and Postpartum—United States, 2017external icon
Ko JY, Tong VT, Haight SC, et al. J Perinatol. 2020;40(3):412–421.
- Treatment of Substance Use Disorders among Women of Reproductive Age by Depression and Anxiety Disorder Status, 2008–2014 (Journal of Women’s Health, August 2019).external icon
Zhou J, Ko JY, Haight SC, Tong VT, et al. J Womens Health. 2019;28(8):1068–1076.
- Standardization of State Definitions for Neonatal Abstinence Syndrome Surveillance and the Opioid Crisis (American Journal of Public Health, August 2019external icon.
Chiang KV, Okoroh EM, Kasehagen LJ, Garcia-Saavedra LF, Ko JY. Am J Public Health. 2019;109(9):1193–1197.
- Leveraging existing birth defects surveillance infrastructure to build neonatal abstinence syndrome surveillance systems—Illinois, New Mexico, and Vermont, 2015–2016
Lind JN, Ailes EC, Alter CC, et al. MMWR Morb Mortal Wkly Rep. 2019;68(7):177–80.
- Public Health Surveillance of Prenatal Opioid Exposure in Mothers and Infantsexternal icon
Honein MA, Boyle C, Redfield RR. Pediatrics. 2019;143(3):e20183801.
- Gastroschisis Trends and Ecological Link to Opioid Prescription Rates in the United States, 2006–2015
Short TD, Stallings EB, Isenburg J, et al. MMWR Morb Mortal Wkly Rep. 2019;68:31–36.
- Evaluation of State-Mandated Reporting of Neonatal Abstinence Syndrome—Six States, 2013–2017
Jilani SM, Frey MT, Pepin D, et al. MMWR Morb Mortal Wkly Rep. 2019;68(1):6–10.