A nation-wide Swedish study of opioid analgesic prescribing patterns during pregnancy and associated preexisting mental health conditions

Abstract

Introduction

Research has consistently shown individuals with mental health conditions are more likely to be prescribed opioid analgesic medications and to engage in heavier utilization. However, it is unclear whether these findings apply to pregnant women.

Study design

We explored opioid analgesic prescription in 689,400 pregnancies occurring in Sweden between 2007 and 2013. We investigated prescription patterns across time and type of source clinic for any opioid analgesic and for strong and weak opioid analgesics. We further evaluated the extent to which receipt of opioid analgesic medications was associated with previous mental health diagnoses and prescriptions of other psychoactive medications.

Results

The prevalence of pregnant women who filled prescriptions for opioid analgesics (4.5%) was relatively stable across the assessed years. However, among pregnant women who filled opioid analgesic prescriptions, there was a large increase in strong opioid analgesic prescriptions–from 6.1% in 2007 to 17.1% in 2013. The main source of opioid analgesic prescriptions were primary care and obstetrics and gynecology clinics–38.7% of all filled prescriptions originated from primary care providers and 25.3% from obstetrics and gynecology practitioners. Compared to pregnant women who did not fill any opioid analgesic prescriptions, those who did were more likely to have a wide range of preexisting mental health diagnoses (e.g. anxiety disorder odds ratio [OR] = 3.13, 95% confidence interval [CI]:2.98,3.29) and to utilize a wide range of other psychoactive medications (e.g. benzodiazepines OR = 4.26, 95% CI:4.10,4.43). Similarly, those who received strong opioids were more likely to have a wide range of mental health diagnoses and be prescribed a wide range of psychoactive medications compared to those who received weak opioids.

Conclusions

These results highlight the need for physicians treating pregnant women and women of childbearing age for painful conditions to obtain detailed histories of mental health problems, screen for symptoms of mental health problems, and facilitate integrated care and evidence-based mental health interventions if needed.

Keywords:

• Mental health
• opioid analgesics
• pregnancy
• prenatal care
• prenatal diagnosis

Disclosure statement

Dr. Larsson reports having served as a speaker for Evolan and Shire and has receiving research grants from Shire; all outside the submitted work. No other disclosures were reported.

Additional information

Funding

Research reported in this publication was supported by a National Science Foundation Graduate Research Fellowship [1342962], the National Institute on Drug Abuse of the National Institutes of Health [R01DA048042 and R00DA040727], the Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) framework [340-2013-5867], the Swedish Research Council Health, Working Life and Welfare [FORTE; 50623213], and the Swedish Research Council [2014-38313831 and 2018-02679]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders did not play any role in in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.