In a new study led by Vanderbilt University Medical Center researchers, women who filled two or more prescriptions for opioids after childbirth faced a 46% greater risk of death than women who did not.
The study, led by the late Arlyn Horn, PharmD, MPH and Margaret Adgent, MSPH, PhD, research assistant professor in the Division of Pharmacoepidemiology, Department of Health Policy, examined a large cohort of women enrolled in TennCare who gave birth between 2007 and 2015, and compared those who filled two or more prescriptions for opioids in the first 41 days after birth with those who did not.
“Postpartum opioid prescribing is common after childbirth, and for many women, this postpartum period is the first time a woman is exposed to an opioid. Our study demonstrates that such use can have serious consequences as postpartum opioid use is associated with a substantial increase in the risk of maternal death,” said Adgent, co-lead author of the study.
The study, published online in the American Journal of Perinatology, included more than 240,000 live births over the eight-year period, and identified 182 maternal deaths. Nearly 18% of new mothers filled two or more postpartum opioid prescriptions. Among these women, drug overdose was the second-leading cause of death, second only to motor vehicle accidents. Among women who did not fill multiple opioid prescriptions, overdose was the fourth-leading cause of death.
“These findings suggest that overdose is a prevalent cause of postpartum death regardless of postpartum opioid exposure, and that postpartum opioid prescribing may be an influential contributor to this association,” the study said.
Researchers noted in the study that more research is necessary to fully understand the relationship between opioid prescribing and non-overdose causes of death and recommend some health interventions that could help reduce maternal deaths.
“Our findings underscore the need for risk awareness among patients and clinicians, coupled with judicious opioid prescribing practices. Before receiving opioid prescriptions after delivery, women should be counseled on the risks and benefits of opioid medications and the availability of nonnarcotic options,” Adgent said.
The authors made a special tribute to the life and work of Arlyn Horn, PharmD, MPH, a graduate from the Vanderbilt MPH program, who initiated and led this study but passed away before she could see it to publication.
The research was funded by the U.S. Department of Health and Human Services, the National Institutes of Health and Pharmaceutical Research and Manufacturers Foundation.
The team of VUMC investigators also include Sarah S. Osmundson, MD, MS, assistant professor of Obstetrics and Gynecology; Andrew D. Wiese, PhD, MPH, assistant professor of Health Policy; Sharon Phillips MSPH, associate in the Department of Biostatistics; Stephen W. Patrick MD, MPH, associate professor of Pediatrics and Health Policy; Marie R. Griffin MD, MPH, professor emeritus of Health Policy; and Carlos G. Grijalva MD, MPH, professor of Health Policy.