The number of women in the United States found to have opioid use disorder (OUD) at labor and delivery quadrupled between 1999 and 2014, according to a new report.
The first multistate-based analysis of trends showed a significant increase in the national prevalence rate of OUD, as well as in each of the 28 states with multiyear data, report Sarah Haight, MPH, from the Centers for Disease Control and Prevention (CDC), and colleagues.
OUD during pregnancy has been associated with a range of negative health outcomes for both mothers and their babies, including maternal death, preterm birth, stillbirth, and neonatal abstinence syndrome.
"These findings illustrate the devastating impact of the opioid epidemic on families across the US, including on the very youngest," CDC Director Robert R. Redfield, MD, said in a news release.
"Untreated opioid use disorder during pregnancy can lead to heartbreaking results," he added. "Each case represents a mother, a child, and a family in need of continued treatment and support."
The findings were published in the August 10 issue of the CDC's Morbidity and Mortality Weekly Report.
Growing National Problem
Based on data from the National Inpatient Sample, the national prevalence rate of OUD increased from 1.5 per 1000 delivery hospitalizations in 1999 to 6.5 in 2014 — an average annual increase of 0.4 per 1000 delivery hospitalizations per year (P < .05), the authors report.
Their analysis of state inpatient data showed significant increases in all 28 states with at least 3 years of data available for analysis. During the study period, the average annual rate increases were lowest in California and Hawaii (growth of < 0.1 cases per 1000 each year) and highest in Maine, New Mexico, Vermont, and West Virginia (all with growth of > 2.5 cases per 1000 each year).
"Even in states with the smallest annual increases, more and more women are presenting with opioid use disorder at labor and delivery," Wanda Barfield, MD, rear admiral, US Public Health Service, and director of the Division of Reproductive Health, said in the release.
"These state-level data can provide a solid foundation for developing and tailoring prevention and treatment efforts," said Barfield.
The state-level analysis also showed that OUD rates varied by state: The lowest rates were in Washington, DC, and Nebraska (0.7 and 1.2 cases per 1000 hospital births, respectively) and the highest rates were in West Virginia and Vermont (32.1 and 48.6 cases per 1000 hospital births).
While the variability by state may reflect differences in opioid prescribing rates or the prevalence of illicit drug use, it could also reflect improved screening, diagnosis, and treatment of OUD and neonatal abstinence syndrome, write the authors.
"This first multistate analysis of opioid use disorder among delivery hospitalizations can be used by states to monitor the prevalence of opioid use disorder at delivery hospitalizations. There is continued need for national, state, and provider efforts to prevent, monitor, and treat opioid use disorder among reproductive-aged and pregnant women," they add.
To address OUD among pregnant women, the CDC recommends the following actions:
Ensure appropriate opioid prescribing, in line with current guidelines.
Maximize and enhance prescription drug monitoring programs.
Implement universal substance use screening at the first prenatal visit, as recommended by the American College of Obstetricians and Gynecologists.
Ensure pregnant women with OUD have access to medication assisted therapy and related addiction services.
Ensure mothers with OUD receive adequate patient-centered postpartum care, including mental health and substance use treatment, relapse-prevention programs, and family planning services.
The authors have disclosed no relevant financial relationships.
MMWR Morb Mortal Wkly Rep. 2018;67:845-849. Full text
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