title: Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States.
abstract: OBJECTIVE
  To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers.
  
  
  METHODS
  We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status.
  
  
  RESULTS
  Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166-$6,067), compared to $4,084 (95% CI: $4,002-$4,166) for nonusers.
  
  
  CONCLUSIONS
  Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA.
authors.forename: Valerie E
authors.initials: VE
authors.lastname: Whiteman
authors.affiliation: Maternal and Child Health Comparative Effectiveness Research Group, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard MDC 56, Tampa, FL 33612, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Salemi
authors.affiliation: Department of Community and Health Systems, School of Nursing, University of Indiana, 1111 Middle Drive, Indianapolis, IN 46202, USA.
authors.forename: Mulubrhan F
authors.initials: MF
authors.lastname: Mogos
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA.
authors.forename: Mary Ashley
authors.initials: MA
authors.lastname: Cain
authors.affiliation: Department of Health Policy and Medicine, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN 32703, USA.
authors.forename: Muktar H
authors.initials: MH
authors.lastname: Aliyu
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL 33606, USA ; Maternal and Child Health Comparative Effectiveness Research Group, Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, 13201 Bruce B. Downs Boulevard MDC 56, Tampa, FL 33612, USA.
authors.forename: Hamisu M
authors.initials: HM
authors.lastname: Salihu
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000191:economics / Q000453:epidemiology; D007752:Obstetric Labor, Premature / Q000191:economics / Q000453:epidemiology; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D050497:Stillbirth / Q000191:economics / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid