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Prenatal Opioid Analgesics and the Risk of Adverse Birth Outcomes
- Source :
- Epidemiology (Cambridge, Mass.)
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Supplemental Digital Content is available in the text.<br />Background: It is unclear whether confounding accounts for the increased risk of preterm birth and small for gestational age (SGA) birth in opioid analgesic exposed pregnancies. Methods: Using universal coverage health data for Ontario, we assembled a cohort of mother–infant pairs without opioid use disorder (627,172 pregnancies and 509,522 women). We estimated risk ratios (RRs) between opioid analgesics and preterm birth, SGA birth, and stillbirth; neonatal abstinence syndrome was a secondary outcome. We used high-dimensional propensity scores and sensitivity analyses for confounding adjustment. Results: 4% of pairs were exposed, mainly to codeine (2%), morphine (1%), and oxycodone (1%). Compared with unexposed, the adjusted risk of preterm birth was higher with any (1.3, 95% confidence interval [CI] = 1.2, 1.3), first- (RR: 1.2, 95% CI = 1.2, 1.3), and second-trimester (RR: 1.3, 95% CI = 1.2, 1.4) opioid analgesic exposure. Preterm birth risk was higher for first- and second-trimester codeine, morphine, and oxycodone exposure, and for third-trimester morphine. There was a small increase in SGA with first-trimester exposure to any opioid analgesic or to codeine. Exposed pregnancies had an elevated stillbirth risk with any (RR: 1.6, 95% CI = 1.4, 1.8), first- and second-trimester exposure. Few infants had neonatal abstinence syndrome (N = 143); the risk was higher in exposed (RR: 3.6, 95% CI = 2.1, 6.0). In sensitivity analyses of unmeasured confounding, an elevated risk in exposed pregnancies persisted for preterm birth but not SGA. Conclusions: Opioid analgesic-exposed pregnancies had a small increased risk of preterm birth and possibly stillbirth after accounting for confounding by indication and sociodemographic factors.
- Subjects :
- medicine.medical_specialty
Epidemiology
01 natural sciences
Neonatal abstinence syndrome
010104 statistics & probability
03 medical and health sciences
0302 clinical medicine
Pregnancy
medicine
Humans
Confounding
030212 general & internal medicine
0101 mathematics
Ontario
business.industry
Obstetrics
Pharmacoepidemiology
Infant, Newborn
Pregnancy Outcome
Infant
Preterm birth
Opioid use disorder
Stillbirth
medicine.disease
Analgesics, Opioid
Small for gestational age birth
Opioid
Opioid analgesics
Relative risk
Infant, Small for Gestational Age
Cohort
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING
Premature Birth
Small for gestational age
Female
business
Oxycodone
medicine.drug
Subjects
Details
- ISSN :
- 10443983
- Volume :
- 32
- Database :
- OpenAIRE
- Journal :
- Epidemiology
- Accession number :
- edsair.doi.dedup.....8a515295be2c66cbbb665b8c258a88ed