CDC Report Finds Quarter of Women Use Opioids, Raises Concern for Risks of Birth Defects

CDC Report Finds Quarter of Women Use Opioids, Raises Concern for Risks of Birth Defects
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February 2, 2015

A study by the Centers for Disease Control (CDC) analyzed the use of opioid painkillers by women of childbearing age, but the U.S. Food and Drug Administration (FDA) says there isn't enough data to provide new recommendations for the use of painkillers during pregnancy.

The study found that between 2008 and 2012, 39 percent of Medicaid-enrolled women between the ages of 15 and 44 filled at least one opioid prescription every year, compared to 28 percent of women with private insurance.

Opioids like Vicodin and Oxycontin are generally prescribed to treat moderate to severe pain, but studies suggest that using these medications during pregnancy – particularly the first trimester - could increase the risk of birth defects, particularly with the baby's brain, spine, heart and abdominal wall. The numbers raise a particular concern because it could take at least a few weeks for a woman to realize she is pregnant and half of all U.S. pregnancies are unplanned.

Geographically, among those with private insurance, opioid prescription rates were highest for women living the South and lowest in the Northeast. The number of prescriptions was 1.5 times higher among white Medicaid-enrolled woman than non-Hispanic black or Hispanic women. Both results similar outcomes for other analysis for opioid use.

Despite the number of women being prescribed opioids, the FDA has not issued any new recommendations for their use during pregnancy.

The FDA reviewed studies on prescriptions NSAIDs, like ibuprofen, and the risk of miscarriage in the first half of pregnancy, the use of opioids during the first trimester and the risk of birth defects, and the use of acetaminophen (Tylenol) at any time during pregnancy and the risk of children born with attention deficit hyperactivity disorder.

After evaluating published research studies, the FDA determined they are too limited to make any recommendations, and their use should be carefully considered by doctors and their patients.

"We found all the studies we reviewed to have potential limitations in their designs; sometimes the accumulated studies on a topic contained conflicting results that prevented us from drawing reliable conclusions," said agency officials in a statement.

Laughing Gas in the Delivery Room

Although the safety of OTC and prescription painkillers during pregnancy is still being reviewed, more hospitals are offering laughing gas to take the edge off during labor.

Commonly used in dentist offices, nitrous oxide is increasingly being used as an alternative to epidurals, which is much more effective in reducing pain. Nitrous oxide, however, is cheaper, costing about one tenth of an epidural.

While laughing gas is being used more often and in more hospitals, it's still relativity unpopular with only 1 percent of U.S. women using it. Comparatively, more than a decade ago, 62 percent of women in the United Kingdom used it during labor.

Unlike an epidural, which is administered to the spine and desensitizes the lower half of the body like a local anesthetic, laughing gas is administered by the patient, who controls how much she uses and when she uses it. Unlike other traditional pain management options laughing gas doesn't take the pain away, but it helps patients ignore it for a few minutes. Also nitrous oxide doesn't pass through the liver like narcotics and is expelled from the body with the first breath of fresh air.

"If a woman doesn't like the way she's feeling with the gas, she can just take off the mask and it's gone," Elizabeth Kester of New Hampshire-based Monadnock Community Hospital said in an interview with the Atlantic. "With narcotics or an epidural if a woman doesn't like the way it feels, she kind of out of luck."

For North Carolina women interested in laughing gas, UNC Hospitals now offers it as an option.