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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Pharmacology

Background:

  • Opioid use during the childbirth period is common for pain management.
  • Understanding the long-term consequences of this exposure is crucial for patient safety.
  • Persistent postpartum opioid use poses significant health risks.

Purpose of the Study:

  • To examine the association between opioid exposure around childbirth and persistent postpartum opioid use.
  • To investigate if specific opioid medications are linked to higher risks of long-term use.
  • To identify risk factors for sustained opioid use after delivery.

Main Methods:

  • Retrospective cohort study using Pennsylvania Medicaid claims (2015-2021).
  • Included women aged 19-50 with vaginal or cesarean delivery and continuous Medicaid enrollment.
  • Defined exposure as filled opioid prescriptions during the childbirth period (7 days pre-delivery to 8 weeks postpartum).
  • Defined persistent postpartum opioid use as opioid use disorder diagnosis or repeated opioid prescriptions from 8 weeks to 14 months postpartum.

Main Results:

  • Childbirth opioid exposure was present in 25% of births; 5.7% experienced persistent postpartum opioid use.
  • Patients with childbirth opioid exposure had a 1.88 times higher odds of persistent postpartum use compared to unexposed individuals.
  • Among opioid-naïve individuals, childbirth opioid exposure increased the odds of persistent use by 2.66 times.
  • Tramadol exposure was associated with the highest risk of persistent use (30.9%) compared to oxycodone (7.3%).

Conclusions:

  • Opioid use for childbirth pain management is significantly associated with persistent postpartum opioid use.
  • This association holds true for opioid-naïve patients and those without pre-existing pain conditions.
  • Findings emphasize the need for careful pain management strategies balancing efficacy with opioid risk minimization and improved postpartum care coordination.