Research
Obstetrics
Maternal treatment with opioid analgesics and risk for birth defects

Presented at the 14th Annual Maternal and Child Health Epidemiology Conference, Atlanta, GA, Dec. 10-12, 2008; the 56th Annual Epidemic Intelligence Service Conference, Atlanta, GA, April 20-24, 2009; the 49th Annual Meeting of the Teratology Society, Rio Grande, Puerto Rico, June 27-July 1, 2009; the 30th Annual David W. Smith Workshop on Malformations and Morphogenesis, Philadelphia, PA, Aug. 5-9, 2009; and the 25th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, Providence, RI, Aug. 17-19, 2009.
https://doi.org/10.1016/j.ajog.2010.12.039Get rights and content

Objective

We examined whether maternal opioid treatment between 1 month before pregnancy and the first trimester was associated with birth defects.

Study Design

The National Birth Defects Prevention Study (1997 through 2005) is an ongoing population-based case-control study. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIS) for birth defects categories with at least 200 case infants or at least 4 exposed case infants.

Results

Therapeutic opioid use was reported by 2.6% of 17,449 case mothers and 2.0% of 6701 control mothers. Treatment was statistically significantly associated with conoventricular septal defects (OR, 2.7; 95% CI, 1.1–6.3), atrioventricular septal defects (OR, 2.0; 95% CI, 1.2–3.6), hypoplastic left heart syndrome (OR, 2.4; 95% CI, 1.4–4.1), spina bifida (OR, 2.0; 95% CI, 1.3–3.2), or gastroschisis (OR, 1.8; 95% CI, 1.1–2.9) in infants.

Conclusion

Consistent with some previous investigations, our study shows an association between early pregnancy maternal opioid analgesic treatment and certain birth defects. This information should be considered by women and their physicians who are making treatment decisions during pregnancy.

Section snippets

Materials and Methods

We analyzed data from the National Birth Defects Prevention Study (NBDPS) for infants born Oct. 1, 1997, through Dec. 31, 2005. NBDPS is an ongoing multisite population-based case-control study of >30 types of major structural birth defects that focuses on exposures immediately before and during pregnancy. Each of the study sites (Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, North Carolina, Texas, and Utah) ascertains deliveries with birth defects through birth

Results

Of the 17,449 mothers of case infants with various included birth defects, 454 (2.6%) reported opioid analgesic treatment between 1 month before and 3 months after conception. Among 6701 control mothers, 134 (2.0%) reported treatment in this time period. The most commonly reported opioids were codeine (34.5%), hydrocodone (34.5%), oxycodone (14.4%), and meperidine (12.9%), with codeine and hydrocodone exposure being slightly more common among cases, and oxycodone and meperidine exposure

Comment

Using data from a large population-based case-control study, we found associations between maternal therapeutic use of opioid medications in early pregnancy and several types of CHD, consistent with some previous findings for first-trimester use of the opioid codeine.14, 15, 16 Previous reports considered associations with CHD as a single group; we also found a statistically significant association with an aggregate group that includes infants with any 1 of the 15 NBDPS-eligible diagnostic

Acknowledgments

Coding of drug information in NBDPS used the Slone Drug Dictionary, under license from the Slone Epidemiology Center at Boston University, Boston, MA. Centers participating in the NBDPS: University of Arkansas for Medical Sciences, Little Rock, AR (Charlotte Hobbs, MD; U50/CCU613236); California March of Dimes, Oakland, CA (Gary Shaw, DrPH; U50/CCU913241); University of Iowa, Iowa City, IA (Paul Romitti, PhD; U50/CCU713238); Massachusetts Department of Public Health, Boston, MA (Marlene

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    This work was supported through cooperative agreements under Program Announcement no. 02081 from the Centers for Disease Control and Prevention to the centers participating in the National Birth Defects Prevention Study, listed as Acknowledgments in this article.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

    Cite this article as: Broussard CS, Rasmussen SA, Reefhuis J, et al. Maternal treatment with opioid analgesics and risk for birth defects. Am J Obstet Gynecol 2011;204:314.e1-11.

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