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Originally published Monday, April 14, 2014 at 9:06 PM

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Surge in use of opioid painkillers during pregnancy

Doctors are prescribing opioid painkillers to pregnant women in astonishing numbers, new research shows, even though risks to the developing fetus are largely unknown.


The New York Times

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Doctors are prescribing opioid painkillers to pregnant women in astonishing numbers, new research shows, even though risks to the developing fetus are largely unknown.

Of 1.1 million pregnant women enrolled in Medicaid nationally, nearly 23 percent filled an opioid prescription in 2007, up from 18.5 percent in 2000, according to a study published last week in the journal Obstetrics & Gynecology. That percentage is the largest to date of opioid prescriptions among pregnant women. Medicaid covers the medical expenses for 45 percent of births in the United States.

The lead author, Rishi Desai, a research fellow at Brigham and Women’s Hospital, said he had expected to “see some increase in trend, but not this magnitude.”

“One in 5 women using opioids during pregnancy is definitely surprising,” he added.

In February, a study of 500,000 privately insured women found that 14 percent were dispensed opioid painkillers at least once during pregnancy. From 2005 to 2011, the percentage of pregnant women prescribed opioids decreased slightly, but the figure exceeded 12 percent in any given year, according to Dr. Brian Bateman, an anesthesiologist at Massachusetts General Hospital, and his colleagues. Their research was published in Anesthesiology.

Dr. Joshua Copel, a professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, said he was taken aback by the findings, which come even as conscientious mothers-to-be increasingly view pregnancy as a time to skip caffeine, sushi and even cold cuts.

In both studies, the opioids most prescribed during pregnancy were codeine and hydrocodone. Oxycodone was among the top four. Women usually took the drugs for a week or less; still, just over 2 percent of women in both studies took them for longer periods.

Rates of opioid prescriptions were highest in the South and lowest in the Northeast. The differences were stark: In the study of women enrolled in Medicaid, 41.6 percent of pregnant women in Utah were prescribed opioids, and 35.6 percent in Idaho.

Oregon had the lowest, at 9.5 percent, with New York at 9.6 percent.

“The regional variation really concerned me the most,” said Dr. Pamela Flood, a professor of anesthesiology and pain medicine at Stanford University. “It’s hard to imagine that pregnant women in the South have all that much more pain than pregnant women in the Northeast.”

Prescribing rates for opioids vary widely among adults between states and even adjacent counties, suggesting a lack of attention to potential misuse and abuse in areas with high rates.

The reasons behind the surge in use are unclear.

Pregnancy has always entailed discomfort. A growing fetus may place pressure on the mother’s nerves, causing sciatica. Weight gain, posture changes and pelvic- floor dysfunction all can result in discomfort and pain for mothers-to-be.



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