Characteristics of Individuals in the United States Who Used Opioids during Pregnancy

Ruby H.N. Nguyen; Emily A. Knapp; Xiuhong Li; Carlos A. Camargo; Elisabeth Conradt; Whitney Cowell; Karen J. Derefinko; Amy J. Elliott; Alexander M. Friedman; Gurjit K. Khurana Hershey; Julie A. Hofheimer; Barry M. Lester; Cindy T. McEvoy; Jenae M. Neiderhiser; Emily Oken; Steven J. Ondersma; Sheela Sathyanarayana; Meagan E. Stabler; Annemarie Stroustrup; Irene Tung; Monica McGrath

doi:10.1089/jwh.2022.0118

Characteristics of Individuals in the United States Who Used Opioids during Pregnancy

Ruby H.N. Nguyen, Emily A. Knapp, Xiuhong Li, Carlos A. Camargo, Elisabeth Conradt, Whitney Cowell, Karen J. Derefinko, Amy J. Elliott, Alexander M. Friedman, Gurjit K. Khurana Hershey, Julie A. Hofheimer, Barry M. Lester, Cindy T. McEvoy, Jenae M. Neiderhiser, Emily Oken, Steven J. Ondersma, Sheela Sathyanarayana, Meagan E. Stabler, Annemarie Stroustrup, Irene TungMonica McGrath

Epidemiology

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental Influences on Child Health Outcomes (ECHO) Program, and determined which characteristics were associated with opioid use during pregnancy. Materials and Methods: Cross-sectional data obtained from 21,905 pregnancies of individuals across the United States enrolled in the ECHO between 1990 and 2021 were analyzed. Medical records, laboratory testing, and self-report were used to determine opioid-exposed pregnancies. Multiple imputation methods using fully conditional specification with a discriminant function accounted for missing characteristics data. Results: Opioid use was present in 2.8% (n = 591) of pregnancies. The majority of people who used opioids in pregnancy were non-Hispanic White (67%) and had at least some college education (69%). Those who used opioids reported high rates of alcohol use (32%) and tobacco use (39%) during the pregnancy; although data were incomplete, only 5% reported heroin use and 86% of opioid use originated from a prescription. After adjustment, non-Hispanic White race, pregnancy during the years 2010-2012, higher parity, tobacco use, and use of illegal drugs during pregnancy were each significantly associated with opioid use during pregnancy. In addition, maternal depression was associated with increased odds of opioid use during pregnancy by more than two-fold (adjusted odds ratio 2.42, 95% confidence interval: 1.95-3.01). Conclusions: In this large study of pregnancies from across the United States, we found several factors that were associated with opioid use among pregnant people. Further studies examining screening for depression and polysubstance use may be useful for targeted interventions to prevent detrimental opioid use during pregnancy, while further elucidation of the reasons for use of prescription opioids during pregnancy should be further explored.

Original language	English (US)
Pages (from-to)	161-170
Number of pages	10
Journal	Journal of Women's Health
Volume	32
Issue number	2
DOIs	https://doi.org/10.1089/jwh.2022.0118
State	Published - Feb 1 2023

Bibliographical note

Funding Information:
This work was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), and 5UH3OD023320-05 (Aschner), UG3OD023337 (Wright), UH3OD023268 (Litonjua), 4UH3OD023248-03 (Dabelea), 5UH3OD023348-05 (O'Shea), 4UH3OD023328-03 (Duarte), UH3OD023279 (Elliott), 4UH3OD023342 (Newschaffer), UH3OD023289 (Ferrara), 4UH3OD023365-03 (Hertz-Picciotto), 4UH3OD023244-03 (Hipwell), 4UH3OD023275-03 (Karagus), UH3OD023347 (Lester), UH3OD023347 (McEvoy), UH3 OD023389 (Leve), UH3 OD023349 (O'Connor), R01 HD 034568 and UH3OD 023286 (Oken), 4UH3OD023271-03 (Karr, Sathyanarayana), UH3 OD023285 (Paneth), 4UH3OD023282-03 (Gern). The authors wish to thank our ECHO colleagues and contributors, and the following ECHO program collaborators: Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: Benjamin DK, Smith PB, Newby KL; and the Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland: Jacobson LP; Research Triangle Institute, Durham, North Carolina: Parker CB; the ECHO cohorts listed in Supplemental Data . Data utilized in these analyses may be available through approval from individual study investigators and the ECHO program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.

Keywords

opioids
pregnancy
substance use

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural

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Nguyen, R. H. N., Knapp, E. A., Li, X., Camargo, C. A., Conradt, E., Cowell, W., Derefinko, K. J., Elliott, A. J., Friedman, A. M., Khurana Hershey, G. K., Hofheimer, J. A., Lester, B. M., McEvoy, C. T., Neiderhiser, J. M., Oken, E., Ondersma, S. J., Sathyanarayana, S., Stabler, M. E., Stroustrup, A., ... McGrath, M. (2023). Characteristics of Individuals in the United States Who Used Opioids during Pregnancy. Journal of Women's Health, 32(2), 161-170. https://doi.org/10.1089/jwh.2022.0118

Nguyen, RHN, Knapp, EA, Li, X, Camargo, CA, Conradt, E, Cowell, W, Derefinko, KJ, Elliott, AJ, Friedman, AM, Khurana Hershey, GK, Hofheimer, JA, Lester, BM, McEvoy, CT, Neiderhiser, JM, Oken, E, Ondersma, SJ, Sathyanarayana, S, Stabler, ME, Stroustrup, A, Tung, I & McGrath, M 2023, 'Characteristics of Individuals in the United States Who Used Opioids during Pregnancy', Journal of Women's Health, vol. 32, no. 2, pp. 161-170. https://doi.org/10.1089/jwh.2022.0118

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abstract = "Background: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental Influences on Child Health Outcomes (ECHO) Program, and determined which characteristics were associated with opioid use during pregnancy. Materials and Methods: Cross-sectional data obtained from 21,905 pregnancies of individuals across the United States enrolled in the ECHO between 1990 and 2021 were analyzed. Medical records, laboratory testing, and self-report were used to determine opioid-exposed pregnancies. Multiple imputation methods using fully conditional specification with a discriminant function accounted for missing characteristics data. Results: Opioid use was present in 2.8% (n = 591) of pregnancies. The majority of people who used opioids in pregnancy were non-Hispanic White (67%) and had at least some college education (69%). Those who used opioids reported high rates of alcohol use (32%) and tobacco use (39%) during the pregnancy; although data were incomplete, only 5% reported heroin use and 86% of opioid use originated from a prescription. After adjustment, non-Hispanic White race, pregnancy during the years 2010-2012, higher parity, tobacco use, and use of illegal drugs during pregnancy were each significantly associated with opioid use during pregnancy. In addition, maternal depression was associated with increased odds of opioid use during pregnancy by more than two-fold (adjusted odds ratio 2.42, 95% confidence interval: 1.95-3.01). Conclusions: In this large study of pregnancies from across the United States, we found several factors that were associated with opioid use among pregnant people. Further studies examining screening for depression and polysubstance use may be useful for targeted interventions to prevent detrimental opioid use during pregnancy, while further elucidation of the reasons for use of prescription opioids during pregnancy should be further explored.",

keywords = "opioids, pregnancy, substance use",

author = "Nguyen, {Ruby H.N.} and Knapp, {Emily A.} and Xiuhong Li and Camargo, {Carlos A.} and Elisabeth Conradt and Whitney Cowell and Derefinko, {Karen J.} and Elliott, {Amy J.} and Friedman, {Alexander M.} and {Khurana Hershey}, {Gurjit K.} and Hofheimer, {Julie A.} and Lester, {Barry M.} and McEvoy, {Cindy T.} and Neiderhiser, {Jenae M.} and Emily Oken and Ondersma, {Steven J.} and Sheela Sathyanarayana and Stabler, {Meagan E.} and Annemarie Stroustrup and Irene Tung and Monica McGrath",

note = "Funding Information: This work was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), and 5UH3OD023320-05 (Aschner), UG3OD023337 (Wright), UH3OD023268 (Litonjua), 4UH3OD023248-03 (Dabelea), 5UH3OD023348-05 (O'Shea), 4UH3OD023328-03 (Duarte), UH3OD023279 (Elliott), 4UH3OD023342 (Newschaffer), UH3OD023289 (Ferrara), 4UH3OD023365-03 (Hertz-Picciotto), 4UH3OD023244-03 (Hipwell), 4UH3OD023275-03 (Karagus), UH3OD023347 (Lester), UH3OD023347 (McEvoy), UH3 OD023389 (Leve), UH3 OD023349 (O'Connor), R01 HD 034568 and UH3OD 023286 (Oken), 4UH3OD023271-03 (Karr, Sathyanarayana), UH3 OD023285 (Paneth), 4UH3OD023282-03 (Gern). The authors wish to thank our ECHO colleagues and contributors, and the following ECHO program collaborators: Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: Benjamin DK, Smith PB, Newby KL; and the Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland: Jacobson LP; Research Triangle Institute, Durham, North Carolina: Parker CB; the ECHO cohorts listed in Supplemental Data . Data utilized in these analyses may be available through approval from individual study investigators and the ECHO program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.",

year = "2023",

month = feb,

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doi = "10.1089/jwh.2022.0118",

language = "English (US)",

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T1 - Characteristics of Individuals in the United States Who Used Opioids during Pregnancy

AU - Nguyen, Ruby H.N.

AU - Knapp, Emily A.

AU - Li, Xiuhong

AU - Camargo, Carlos A.

AU - Conradt, Elisabeth

AU - Cowell, Whitney

AU - Derefinko, Karen J.

AU - Elliott, Amy J.

AU - Friedman, Alexander M.

AU - Khurana Hershey, Gurjit K.

AU - Hofheimer, Julie A.

AU - Lester, Barry M.

AU - McEvoy, Cindy T.

AU - Neiderhiser, Jenae M.

AU - Oken, Emily

AU - Ondersma, Steven J.

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AU - Stabler, Meagan E.

AU - Stroustrup, Annemarie

AU - Tung, Irene

AU - McGrath, Monica

N1 - Funding Information: This work was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 (PRO Core), and 5UH3OD023320-05 (Aschner), UG3OD023337 (Wright), UH3OD023268 (Litonjua), 4UH3OD023248-03 (Dabelea), 5UH3OD023348-05 (O'Shea), 4UH3OD023328-03 (Duarte), UH3OD023279 (Elliott), 4UH3OD023342 (Newschaffer), UH3OD023289 (Ferrara), 4UH3OD023365-03 (Hertz-Picciotto), 4UH3OD023244-03 (Hipwell), 4UH3OD023275-03 (Karagus), UH3OD023347 (Lester), UH3OD023347 (McEvoy), UH3 OD023389 (Leve), UH3 OD023349 (O'Connor), R01 HD 034568 and UH3OD 023286 (Oken), 4UH3OD023271-03 (Karr, Sathyanarayana), UH3 OD023285 (Paneth), 4UH3OD023282-03 (Gern). The authors wish to thank our ECHO colleagues and contributors, and the following ECHO program collaborators: Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: Benjamin DK, Smith PB, Newby KL; and the Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland: Jacobson LP; Research Triangle Institute, Durham, North Carolina: Parker CB; the ECHO cohorts listed in Supplemental Data . Data utilized in these analyses may be available through approval from individual study investigators and the ECHO program. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.

PY - 2023/2/1

Y1 - 2023/2/1

N2 - Background: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental Influences on Child Health Outcomes (ECHO) Program, and determined which characteristics were associated with opioid use during pregnancy. Materials and Methods: Cross-sectional data obtained from 21,905 pregnancies of individuals across the United States enrolled in the ECHO between 1990 and 2021 were analyzed. Medical records, laboratory testing, and self-report were used to determine opioid-exposed pregnancies. Multiple imputation methods using fully conditional specification with a discriminant function accounted for missing characteristics data. Results: Opioid use was present in 2.8% (n = 591) of pregnancies. The majority of people who used opioids in pregnancy were non-Hispanic White (67%) and had at least some college education (69%). Those who used opioids reported high rates of alcohol use (32%) and tobacco use (39%) during the pregnancy; although data were incomplete, only 5% reported heroin use and 86% of opioid use originated from a prescription. After adjustment, non-Hispanic White race, pregnancy during the years 2010-2012, higher parity, tobacco use, and use of illegal drugs during pregnancy were each significantly associated with opioid use during pregnancy. In addition, maternal depression was associated with increased odds of opioid use during pregnancy by more than two-fold (adjusted odds ratio 2.42, 95% confidence interval: 1.95-3.01). Conclusions: In this large study of pregnancies from across the United States, we found several factors that were associated with opioid use among pregnant people. Further studies examining screening for depression and polysubstance use may be useful for targeted interventions to prevent detrimental opioid use during pregnancy, while further elucidation of the reasons for use of prescription opioids during pregnancy should be further explored.

AB - Background: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental Influences on Child Health Outcomes (ECHO) Program, and determined which characteristics were associated with opioid use during pregnancy. Materials and Methods: Cross-sectional data obtained from 21,905 pregnancies of individuals across the United States enrolled in the ECHO between 1990 and 2021 were analyzed. Medical records, laboratory testing, and self-report were used to determine opioid-exposed pregnancies. Multiple imputation methods using fully conditional specification with a discriminant function accounted for missing characteristics data. Results: Opioid use was present in 2.8% (n = 591) of pregnancies. The majority of people who used opioids in pregnancy were non-Hispanic White (67%) and had at least some college education (69%). Those who used opioids reported high rates of alcohol use (32%) and tobacco use (39%) during the pregnancy; although data were incomplete, only 5% reported heroin use and 86% of opioid use originated from a prescription. After adjustment, non-Hispanic White race, pregnancy during the years 2010-2012, higher parity, tobacco use, and use of illegal drugs during pregnancy were each significantly associated with opioid use during pregnancy. In addition, maternal depression was associated with increased odds of opioid use during pregnancy by more than two-fold (adjusted odds ratio 2.42, 95% confidence interval: 1.95-3.01). Conclusions: In this large study of pregnancies from across the United States, we found several factors that were associated with opioid use among pregnant people. Further studies examining screening for depression and polysubstance use may be useful for targeted interventions to prevent detrimental opioid use during pregnancy, while further elucidation of the reasons for use of prescription opioids during pregnancy should be further explored.

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KW - pregnancy

KW - substance use

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Characteristics of Individuals in the United States Who Used Opioids during Pregnancy

Abstract

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