title: Receipt of Prescription Opioids in a National Sample of Pregnant Veterans Receiving Veterans Health Administration Care.
abstract: BACKGROUND
  A growing number of reproductive-age women veterans are returning from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). In 2010, 42% of women veterans receiving Veterans Health Administration (VHA) services were aged 18 to 45. Prescription opioid use has increased among all veterans over the past decade; however, exposure among pregnant veterans has not been examined.
  
  
  METHODS
  We identified 2,331 women who delivered babies within the VHA system between 2001 and 2010. Delivery, opioid prescribing history, and demographic and health-related variables were obtained from a national database of veterans receiving VHA services. Receipt of an opioid prescription was defined as any filled VHA prescription for opioids in the 280-day pregnancy window before delivery. We developed a multivariable logistic regression model adjusted for sociodemographic, service-related, psychiatric diagnosis, and physical health variables to examine the odds of filling an opioid prescription during the pregnancy window.
  
  
  RESULTS
  Ten percent of pregnant veterans received VHA prescription opioids during their pregnancy window. Significant factors associated with opioid prescriptions included presence of any psychiatric diagnosis (adjusted odds ratio [aOR], 1.67; 95% CI, 1.24-2.26), diagnosis of back problems (aOR, 2.94; 95% CI, 1.92-4.49), or other nontraumatic joint disorders (aOR, 2.20; 95% CI, 1.36-3.58).
  
  
  CONCLUSIONS
  This study suggests that a substantial proportion of women veterans received VHA prescriptions for opioids during pregnancy. Providers should be aware of the potential risks of prescription opioid use during pregnancy, assess for potential undertreatment of psychiatric diagnoses, and consider alternate pain management strategies when possible.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: aimee.kroll@umassmed.edu.
authors.forename: Aimee R
authors.initials: AR
authors.lastname: Kroll-Desrosiers
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut; Division of General Internal Medicine, University of Connecticut, Farmington, Connecticut; Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut; Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut; Yale Center for Medical Informatics, Yale School of Medicine, New Haven, Connecticut; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Brandt
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
authors.affiliation: Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Neurology, Yale School of Medicine, New Haven, Connecticut; Department of Psychology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Research and Development, VA Central Western Massachusetts, Leeds, Massachusetts.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Mattocks
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D001523:Mental Disorders / Q000175:diagnosis; D008875:Middle Aged; D011247:Pregnancy; D055553:Prescription Drugs / Q000627:therapeutic use*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs