Prescription opioid use in women during pregnancy—a retrospective analysis using Texas Medicaid prescription claims data

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Ghosh, Somraj

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Consequences of the opioid epidemic in the general population have been widely reported in peer-reviewed literature. However, fewer studies have examined the impact of exposure to opioids during pregnancy. The primary objective of this study was to examine the utilization patterns of prescription opioids in pregnant women who were continuously enrolled in Texas Medicaid during the gestation period. The secondary objective of this study was to identify significant factors associated with prescription opioid utilization during pregnancy. Using medical and prescription claims data from Texas Medicaid between September 1, 2011 and August 31, 2016, the prevalence rates of prescription opioid use during pregnancy were determined. The overall prevalence rate was 14.7% and prevalence rates during trimesters one, two, and three were 4.0%, 7.1%, and 7.2%, respectively. Two separate repeated measures analysis of variance models (ANOVA) revealed that the mean number of prescription opioid claims (F [2, 46,290] = 2402.5, P < 0.0001) per person and the mean total days supply (F [2, 46,290] = 591.8, P < 0.0001) per person significantly varied across all three trimesters. Two separate multivariable linear regression models were fitted to identify significant predictors of total number of prescription opioid claims per person and total days supply per person. In both models, mother’s age at delivery, class of opioids, and rural urban status (all P < 0.0001) were significantly associated with utilization. To our knowledge, this is the first study that utilized Texas Medicaid data to determine prevalence rates and utilization patterns of prescription opioids during pregnancy. The study revealed that while the overall prevalence rate of at least one prescription opioid claim during the gestation period was lower than prior reports in the literature, the mean number of total prescription opioid claims per person and total days supply per person were significantly higher in the third trimester compared to the second, and significantly higher in the second trimester compared to the first. The results from this study could potentially drive future policies and guidelines to inform maternal opioid exposure during pregnancy, particularly with respect to the state of Texas


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