Nationwide, the rate of opioid use disorder among women delivering babies more than quadrupled over the 15-year period ending in 2014, according to a Morbidity and Mortality Weekly Report published Thursday by the US Centers for Disease Control and Prevention.
Use of opioid drugs, whether heroin or prescription painkillers, during pregnancy harms the health of both mother and child and can lead to stillbirth, preterm labor, neonatal abstinence syndrome and, in some cases, death of the mother.
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"More and more women are presenting with opioid use disorder at labor and delivery," Dr. Wanda Barfield, director of the CDC's Division of Reproductive Health, said in a statement. She added that the data included in the new report can provide a "solid foundation for developing and tailoring prevention and treatment efforts."
Lowest state rates and highest
The CDC researchers, who did not include Barfield, analyzed hospital discharge data from the US Department of Health and Human Service's Healthcare Cost and Utilization Project to characterize trends from 1999 through 2014.
During that time, the national prevalence of opioid use disorder diagnoses among women giving birth in hospitals increased 333%, from 1.5 cases per 1,000 deliveries to 6.5. This amounts to an average annual increase of 0.4 per 1,000 hospital deliveries per year.
The CDC's analysis is based on data available for only 30 states.
In 1999, the prevalence of opioid use disorder ranged from 0.1 per 1,000 hospital deliveries in Iowa to 8.2 in Maryland. In 2014, prevalence ranged from 0.7 in the District of Columbia to 48.6 in Vermont. Prevalence also exceeded 30 per 1,000 hospital deliveries in West Virginia in 2014, while at the opposite end of the spectrum, Nebraska had the second lowest rate at 1.2 per 1,000.
Over the study period, average rate increases in opioid use disorder were lowest in California and Hawaii, where growth amounted to fewer than 0.1 cases per 1,000 deliveries each year, and highest in Maine, New Mexico, Vermont and West Virginia -- all with an annual growth of more than 2.5 cases of opioid use disorder diagnosed per 1,000 deliveries.
Different state policies might contribute to this variability, the CDC authors believe. As of July, eight states required health care professionals to test for prenatal drug exposure when it is suspected, while 24 states and the District of Columbia require professionals to report suspected use among pregnant women. Twenty-three states and D.C. consider substance use during pregnancy to be child abuse, and three states consider it to be grounds for admitting a woman involuntarily into a psychiatric hospital.
Still, the CDC researchers noted that strict policies could cause women to try to conceal substance use from their providers. "Data on the impact of these policies are scarce," the authors concluded.
The report offers a glimpse of one special group within the many faces caught in America's opioid epidemic.
Dr. Elizabeth E. Krans, an assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at the University of Pittsburgh, wrote in a paper published in July that "an expanded, socioeconomically and demographically diverse population" has become addicted to opioids over time.
Epidemic 'touched everyone'
In the 1960s, more than 80% of patients entering treatment programs for opioid abuse were urban men who used heroin, Krans and her co-author wrote. But by 2010, the majority were women, often middle-class, living in less-urban or rural areas, and over 90% were white.
The opioid epidemic has "touched everyone," Krans, who was not involved in the new CDC report, told CNN. "When something is so broad and affects all populations, we also see it reflected in the pregnant population.
"Pregnancy is a really important time. Women are often worried that invested in their own health and the health of their baby, but they're also fearful of judgment," Krans said. Pregnant women are fearful that people will treat them negatively or, in the worst cases, remove their babies, she said.
"We have effective treatments that are available during pregnancy, and we want to encourage women to seek early care and engage in treatment as soon as possible," Krans said, adding that pharmacological treatments include bupenorphrine and methadone.
At Magee-Womens Hospital of University of Pittsburgh Medical Center, where she works, services for pregnant women with opioid use disorder include social services, psychiatric and behavioral health support, and pediatric and neonatal support after delivery. "We're trying to take a comprehensive approach," she said.
The American College of Obstetricians and Gynecologists recommends universal substance use screening at the first prenatal visit to manage opioid use disorder, according to the CDC.
"Arranging for pregnant patients with opioid use disorder to deliver at facilities prepared to monitor and care for infants with neonatal abstinence syndrome can facilitate access to appropriate care," the CDC researchers wrote. "After delivery, women might need referrals to postpartum psychosocial support services, substance-use treatment, and relapse-prevention programs."
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