Opioid Use in Women of Reproductive Age

Public health officials suggest that opioid use should be better monitored and assessed among women of reproductive age.

There is concern over widespread use of opioids among women aged 15 to 44 years. Opioid use in pregnancy has been associated with neonatal abstinence syndrome and birth defects, including neural tube defects, gastroschisis, and congenital heart defects. Birth defects related to opioid use generally result when the drug is used within the first few weeks of pregnancy, which is often before a woman is aware she is pregnant. Given that most pregnancies are unplanned, and the already known risks associated with opioid exposure in pregnancy, there is reason for clinicians and public health officials to better monitor the situation, a new report from the CDC suggests.

Pertinent Points:

- Widespread use of prescription narcotics should be better monitored among women of reproductive age to prevent prenatal exposure to opioids, a CDC report suggests.

- Physicians should be more judicious in their prescribing of opioids to women of reproductive age, counseling them about adverse effects to a fetus and the important of birth control when taking the pain killers.

"If you are using an opioid pain killer, you should also be practicing effective birth control," said José F. Cordero, MD, MPH, a pediatrician and birth defects expert formerly at CDC and current member of the March of Dimes Board of Trustees, in a news release issued by the March of Dimes.

Cordero urged physicians and other prescribers not to write prescriptions for opioid-based painkillers for their female patients who may become pregnant without a discussion of the risks and safer alternatives.

The report notes that more than one-fourth of privately insured and one-third of Medicaid-enrolled women of childbearing age filled prescriptions for narcotic painkillers between 2008 and 2012. Throughout the 5-year timeframe, the number of opioid prescription claims were consistently higher among Medicaid-enrolled women than their privately insured counterparts, the authors reported.

Opioid prescription claims were highest in 2009, with 29.1% of privately insured women and 41.4% of Medicaid-enrolled women filling a prescription, the data revealed. The most commonly prescribed opioids were hydrocodone, codeine, and oxycodone.

“Many women need to take opioid-containing medications to appropriately manage their health conditions; however, in some instances safer alternative treatments are available and use of opioids is unnecessary,” the authors wrote. “Having a better understanding of prescription opioid use just before and during early pregnancy can help inform targeted interventions to reduce unnecessary prescribing of opioids and provide evidence-based information to health care providers and women about the risks of prenatal opioid exposure.”