title: Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes.
abstract: BACKGROUND
  The authors investigated nationwide trends in opioid abuse or dependence during pregnancy and assessed the impact on maternal and obstetrical outcomes in the United States.
  
  
  METHODS
  Hospitalizations for delivery were extracted from the Nationwide Inpatient Sample from 1998 to 2011. Temporal trends were assessed and logistic regression was used to examine the associations between maternal opioid abuse or dependence and obstetrical outcomes adjusting for relevant confounders.
  
  
  RESULTS
  The prevalence of opioid abuse or dependence during pregnancy increased from 0.17% (1998) to 0.39% (2011) for an increase of 127%. Deliveries associated with maternal opioid abuse or dependence compared with those without opioid abuse or dependence were associated with an increased odds of maternal death during hospitalization (adjusted odds ratio [aOR], 4.6; 95% CI, 1.8 to 12.1, crude incidence 0.03 vs. 0.006%), cardiac arrest (aOR, 3.6; 95% CI, 1.4 to 9.1; 0.04 vs. 0.01%), intrauterine growth restriction (aOR, 2.7; 95% CI, 2.4 to 2.9; 6.8 vs. 2.1%), placental abruption (aOR, 2.4; 95% CI, 2.1 to 2.6; 3.8 vs. 1.1%), length of stay more than 7 days (aOR, 2.2; 95% CI, 2.0 to 2.5; 3.0 vs. 1.2%), preterm labor (aOR, 2.1; 95% CI, 2.0 to 2.3; 17.3 vs. 7.4%), oligohydramnios (aOR, 1.7; 95% CI, 1.6 to 1.9; 4.5 vs. 2.8%), transfusion (aOR, 1.7; 95% CI, 1.5 to 1.9; 2.0 vs. 1.0%), stillbirth (aOR, 1.5; 95% CI, 1.3 to 1.8; 1.2 vs. 0.6%), premature rupture of membranes (aOR, 1.4; 95% CI, 1.3 to 1.6; 5.7 vs. 3.8%), and cesarean delivery (aOR, 1.2; 95% CI, 1.1 to 1.3; 36.3 vs. 33.1%).
  
  
  CONCLUSIONS
  Opioid abuse or dependence during pregnancy is associated with considerable obstetrical morbidity and mortality, and its prevalence is dramatically increasing in the United States. Identifying preventive strategies and therapeutic interventions in pregnant women who abuse drugs are important priorities for clinicians and scientists.
authors.affiliation: From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.M., C.R.C., L.R.L.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (B.T.B.); and Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (A.A.C.).
authors.forename: Ayumi
authors.initials: A
authors.lastname: Maeda
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.forename: Caitlin R
authors.initials: CR
authors.lastname: Clancy
authors.forename: Andreea A
authors.initials: AA
authors.lastname: Creanga
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Leffert
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology; D009293:Opioid-Related Disorders / Q000150:complications* / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D015995:Prevalence; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult