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Research

Opioid use during pregnancy: a population-based cohort study

Jamie Falk, Matthew Dahl, Colette B. Raymond, Dan Chateau, Alan Katz, Christine Leong and Shawn Bugden
June 27, 2017 5 (2) E517-E523; DOI: https://doi.org/10.9778/cmajo.20160102
Jamie Falk
College of Pharmacy, Rady Faculty of Health Sciences (Falk, Leong, Bugden), and Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Raymond, Chateau, Katz), University of Manitoba, Winnipeg, Man.
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Matthew Dahl
College of Pharmacy, Rady Faculty of Health Sciences (Falk, Leong, Bugden), and Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Raymond, Chateau, Katz), University of Manitoba, Winnipeg, Man.
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Colette B. Raymond
College of Pharmacy, Rady Faculty of Health Sciences (Falk, Leong, Bugden), and Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Raymond, Chateau, Katz), University of Manitoba, Winnipeg, Man.
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Dan Chateau
College of Pharmacy, Rady Faculty of Health Sciences (Falk, Leong, Bugden), and Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Raymond, Chateau, Katz), University of Manitoba, Winnipeg, Man.
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Alan Katz
College of Pharmacy, Rady Faculty of Health Sciences (Falk, Leong, Bugden), and Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Raymond, Chateau, Katz), University of Manitoba, Winnipeg, Man.
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Christine Leong
College of Pharmacy, Rady Faculty of Health Sciences (Falk, Leong, Bugden), and Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Raymond, Chateau, Katz), University of Manitoba, Winnipeg, Man.
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Shawn Bugden
College of Pharmacy, Rady Faculty of Health Sciences (Falk, Leong, Bugden), and Manitoba Centre for Health Policy, Department of Community Health Sciences (Dahl, Raymond, Chateau, Katz), University of Manitoba, Winnipeg, Man.
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Article Figures & Tables

Figures

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    Figure 1

    Opioid use for overall pregnancy cohort over study period.

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    Figure 2

    Mean opioid use, as morphine equivalents (MEQ), for opioid users over the study period. Mean MEQ = total MEQ divided by total weighted number of pregnancies among opioid users.

Tables

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    Table 1: Characteristics of the study population for completed pregnancy cohort
    Group; weighted % of women*
    CharacteristicTotal cohort
    n = 175 174
    Non-users
    n = 161 766
    Users
    n = 13 408
    Pregnancy type 
        Live birth99.399.499.0
        Stillbirth or intrauterine death0.70.61.0
    Age at delivery, yr, median (IQR)28 (23-32)28 (23-32)27 (23-32)
    Age at delivery, yr
        ≤ 199.09.17.0
        20-2421.320.826.7
        25-2929.729.729.6
        30-3426.526.724.2
        ≥ 3513.613.712.4
    No. of past pregnancies, including current pregnancy
        129.330.218.5
        228.629.221.0
        317.817.818.3
        ≥ 424.222.742.3
    No. of past deliveries†
        037.638.724.7
        132.032.427.3
        215.715.419.3
        ≥ 314.513.428.7
    Interval between conception date and first pregnancy-related visit, d, median (IQR)72 (52-93)72 (52-93)74 (52-101)
    Income quintile‡
        1 (lowest)26.325.240.0
        220.520.619.2
        318.518.815.7
        418.418.814.0
        5 (highest)15.916.410.7

    Note: IQR = interquartile range.

    *Except where indicated otherwise.

    †Data on number of past deliveries were not available for 0.1% of the total cohort, 0.1% of non-users and 0.1% of users.

    ‡Data on income were not available for 0.4% of the total cohort, 0.4% of non-users and 0.3% of users.

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      Table 2: Opioid use and mean MEQ during pregnancy, by income quintile
      Opioid use, %Average MEQ, mg
      Income quintileAny time during pregnancyAfter first pregnancy-related visitOverallThose using opioids after first pregnancy-related visit
      1 (lowest)11.7*6.9*773†689‡
      27.24.6720615
      36.54.3543497
      45.83.9562486
      5 (highest)5.1*3.7*653†668‡

      Note: MEQ = morphine equivalents.

      *p < 0.001 for comparison of quintiles 1 and 5.

      †p = 0.5 for comparison of quintiles 1 and 5.

      ‡p = 0.9 for comparison of quintiles 1 and 5.

        • View popup
        Table 3: Opioids dispensed
        Opioid20012013
        Use, 
        no. (%) of women*
        MEQ, % of totalUse,
        no. (%) of women*
        MEQ,
        % of total
        Any opioid†n = 937n = 1132
        Codeine922 (98.4)87.81069 (94.4)56.7
        Fentanyl0 (0)-S (< 1)< 1.0
        HydrocodoneS (< 1.0)< 1.00 (0)-
        HydromorphoneS (< 1.0)< 1.011 (1.0)5.3
        Meperidine15 (1.6)4.3S (< 1.0)< 1.0
        MorphineS (< 1.0)6.626 (2.3)18.8
        OxycodoneS (< 1.0)< 1.049 (4.3)18.2
        Tramadol0 (0)-29 (2.6)< 1.0

        Note: MEQ = morphine equivalents, S = suppressed data (for privacy reasons, data are suppressed for any count greater than 1 but less than 5).

        *Percentages may sum to more than 100% because some patients had multiple opioids dispensed.

        †Buprenorphine, butorphanol and dextropropoxyphene were included in the analysis, but had no counts.

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        1 Apr 2017
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        Opioid use during pregnancy: a population-based cohort study
        Jamie Falk, Matthew Dahl, Colette B. Raymond, Dan Chateau, Alan Katz, Christine Leong, Shawn Bugden
        Apr 2017, 5 (2) E517-E523; DOI: 10.9778/cmajo.20160102

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        Opioid use during pregnancy: a population-based cohort study
        Jamie Falk, Matthew Dahl, Colette B. Raymond, Dan Chateau, Alan Katz, Christine Leong, Shawn Bugden
        Apr 2017, 5 (2) E517-E523; DOI: 10.9778/cmajo.20160102
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