CDC Reports Dramatic Increases in Maternal Opioid Use Disorder

Sarah C. Haight, MPH

An analysis by the Centers for Disease Control and Prevention (CDC) reports that the national prevalence of opioid use disorder among women giving birth increased 333% from 1.5 cases per 1000 delivery hospitalizations in 1999 to 6.5 in 2014 (p <0.05).

“These findings illustrate the devastating impact of the opioid epidemic on families across the US, including on the very youngest,” said CDC Director Robert R. Redfield, MD.

Researchers used data from the Agency for Healthcare Research and Quality’s (AHRQ) Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample to find that the national prevalence of opioid use disorder among women giving birth increased by 0.39 cases per 1000 per year from 1999 to 2014. However, the prevalence varies across US states widely, and just 28 states had data for at least 3 years available.

In 1999, the state with the lowest reported prevalence was Iowa with 0.1 cases per 1000, while the highest was Maryland with 8.2, of the 14 states with data available for that year. By 2014, the state-by-state prevalence ranged from 0.7 cases per 1000 in the District of Columbia (DC) up to 48.6 in Vermont.

“Even in states with the smallest annual increases, more and more women are presenting with opioid use disorder at labor and delivery,” said Wanda Barfield, MD, MPH, FAAP, Rear Admiral, US Public Health Service (USPHS), and director, Division of Reproductive Health. “These state-level data can provide a solid foundation for developing and tailoring prevention and treatment efforts.”

Earlier this week, the US Food and Drug Administration (FDA) issued new scientific recommendations to spur the development of new medication-assisted treatment (MAT) drugs for opioid use disorder.

“As we seek to help those with an opioid use disorder transition to lives of sobriety, we recognize there’s great interest in new treatment options that result in meaningful outcomes for patients,” FDA Commissioner Scott Gottlieb, MD. “For example, we must consider new ways to gauge success beyond simply whether a patient in recovery has stopped using opioids, such as reducing relapse overdoses and infectious disease transmission.”

The CDC study acknowledged that the dramatic increase in opioid use disorder at delivery hospitalization may represent improved screening and diagnosis in addition to actual increases. The authors additionally addressed some of the measures that can make a positive impact and reduce the number of pregnant women with OUD.

“Continued national, state, and provider efforts to prevent, monitor, and treat opioid use disorder among reproductive-aged and pregnant women are needed,” wrote study authors Sarah C. Haight, MPH, Jean Y. Ko, PhD, Van T. Tong, MPH, et al.

They suggested efforts including improved access to data in prescription drug monitoring programs, greater substance abuse screening, use of medication-assisted therapy, and treatment referrals for substance abuse.

“Untreated opioid use disorder during pregnancy can lead to heartbreaking results,” said Redfield. “Each case represents a mother, a child, and a family in need of continued treatment and support.”

The report, “Opioid Use Disorder Documented at Delivery Hospitalization — United States, 1999—2014,” was published in the CDC’s Morbidity and Mortality Weekly Report.