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Periconceptional use of opioids and the risk of neural tube defects

Mahsa M Yazdy1, Allen A Mitchell, Sarah C Tinker

  • 1Slone Epidemiology Center at Boston University, Boston, Massachusetts; and the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.

Obstetrics and Gynecology
|October 3, 2013
PubMed

Insights

Maternal opioid use during early pregnancy is linked to a higher risk of neural tube defects in newborns. This study suggests a modest increase in birth defect prevalence associated with periconceptional opioid exposure.

Area of Science:

  • Obstetrics and Gynecology
  • Pediatric Neurology
  • Pharmacology

Background:

  • Opioid analgesics are effective for pain management but their impact on developing fetuses is not fully understood.
  • The periconceptional period is a critical window for organogenesis, making it sensitive to environmental exposures.
  • Neural tube defects (NTDs) are serious congenital anomalies with significant public health implications.

Purpose of the Study:

  • To investigate the association between maternal opioid use in the periconceptional period and the risk of neural tube defects in offspring.
  • To quantify the potential increased risk of NTDs following opioid exposure during early pregnancy.

Main Methods:

  • A case-control study utilizing data from the Slone Epidemiology Center Birth Defects Study (1998-2010).
  • Mothers of 305 infants with NTDs were compared to mothers of 7,125 non-malformed controls and 13,405 malformed controls.
  • Logistic regression models were employed to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for periconceptional opioid use.

Main Results:

  • Mothers reporting opioid use in the periconceptional period had a higher incidence of NTDs compared to both non-malformed (OR 2.2) and malformed (OR 1.9) control groups.
  • The association remained significant when offspring were restricted to those with spina bifida (ORs 2.5 and 2.2, respectively).
  • Periconceptional opioid use was reported by 3.9% of mothers with NTD offspring versus 1.6% and 2.0% in control groups.

Conclusions:

  • Maternal opioid use during the periconceptional period is associated with a modest increased risk of neural tube defects.
  • This association suggests that approximately 5.9 per 10,000 live births may be attributed to NTDs among women using opioids.
  • The findings highlight the importance of considering medication safety during early pregnancy.
Abstract

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