Postpartum Persistent Opioid Use After Opioid Exposure for Childbirth.

OBJECTIVE

To assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure.

METHODS

Retrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use , defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup analysis of the prepregnancy opioid-naïve population.

RESULTS

Of 286,003 births in the Pennsylvania Medicaid program, 172,839 met inclusion criteria (patient demographics: 41,628 Black [24.1%], 102,733 White [59.4%], 26,841 Hispanic [15.5%], mean age at delivery 26.9 years). Childbirth opioid exposure was present in 25% of births (n=43,263). The prevalence of persistent postpartum opioid use was 5.7% (n=9,876). Transition to postpartum persistent use occurred in 7.9% of patients with childbirth opioid exposure and in 4.5% of those without (adjusted odds ratio [aOR] 1.88, 95% CI, 1.79-1.96). Among 132,941 births to opioid-naïve people, 2.6% of patients developed postpartum persistent opioid use; the adjusted odds were higher among those exposed during childbirth compared with those unexposed (aOR, 2.66; 95% CI, 2.49-2.85). The risk of persistent use was highest with tramadol exposure: 30.9% of people exposed to tramadol transitioned to persistent use compared with 7.3% of those exposed to oxycodone (tramadol vs oxycodone: aOR 4.58; 95% CI, 3.87-5.43).

CONCLUSION

Opioid use for childbirth pain management was associated with persistent postpartum use, including among opioid-naïve patients and those without pre-existing pain conditions. These findings support clinical practice guidelines that balance effective postpartum pain management with minimizing opioid-related risks and underscore the importance of postpartum care coordination.