Risk of Death at 1 Year Following Postpartum Opioid Exposure.

Autor:	Horn A; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee., Adgent MA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee., Osmundson SS; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee., Wiese AD; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee., Phillips SE; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee., Patrick SW; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.; Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee., Griffin MR; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Grijalva CG; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.; Veterans' Health Administration, Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee.
Jazyk:	angličtina
Zdroj:	American journal of perinatology [Am J Perinatol] 2024 May; Vol. 41 (7), pp. 949-960. Date of Electronic Publication: 2022 May 31.
DOI:	10.1055/s-0042-1745848
Abstrakt:	Objective: Opioids are commonly prescribed to women for acute pain following childbirth. Postpartum prescription opioid exposure is associated with adverse opioid-related morbidities but the association with all-cause mortality is not well studied. This study aimed to examine the association between postpartum opioid prescription fills and the 1-year risk of all-cause mortality among women with live births. Methods: In a retrospective cohort study of live births among women enrolled in Tennessee Medicaid (TennCare) between 2007 and 2015, we compared women who filled two or more postpartum outpatient opioid prescriptions (up to 41 days of postdelivery discharge) to women who filled one or fewer opioid prescription. Women were followed from day 42 postdelivery discharge through 365 days of follow-up or date of death. Deaths were identified using linked death certificates (2007-2016). We used Cox's proportional hazard regression and inverse probability of treatment weights to compare time to death between exposure groups while adjusting for relevant confounders. We also examined effect modification by delivery route, race, opioid use disorder, use of benzodiazepines, and mental health condition diagnosis. Results: Among 264,135 eligible births, 216,762 (82.1%) had one or fewer maternal postpartum opioid fills and 47,373 (17.9%) had two or more fills. There were 182 deaths during follow-up. The mortality rate was higher in women with two or more fills (120.5 per 100,000 person-years) than in those with one or fewer (57.7 per 100,000 person-years). The risk of maternal death remained higher in participants exposed to two or more opioid fills after accounting for relevant covariates using inverse probability of treatment weighting (adjusted hazard ratio: 1.46 [95% confidence interval: 1.01, 2.09]). Findings from stratified analyses were consistent with main findings. Conclusion: Filling two or more opioid prescriptions during the postpartum period was associated with a significant increase in 1-year risk of death among new mothers. Key Points: · Opioid prescribing in the postpartum period is common.. · Prior studies show that >1 postnatal opioid fill is associated with adverse opioid-related events.. · > 1 opioid fill within 42 days of delivery was associated with an increase in 1-year risk of death.. Competing Interests: M.A.A. reports contracts with the Reagan-Udall Foundation and the Food and Drug Administration and funding from the National Institutes of Health, outside the submitted work. SWP reports grants from National Institute on Drug Abuse, grants from Centers for Medicaid and Medicare Services, grants from The Boedecker Foundation, grants from National Institute on Child Health and Human Development, grants from Robert Wood Johnson Foundation, and grants from National Institute of Mental Health outside the submitted work. M.R.G. reports grant funding from Syneos. C.G.G. has received consulting fees from Pfizer, Sanofi and Merck and received research support from Sanofi-Pasteur, Campbell Alliance, the Centers for Disease Control and Prevention, the National Institutes of Health, the Food and Drug Administration, and the Agency for Healthcare Research and Quality, all outside the submitted work.M.A.A. reported grants/contracts paid to institution: Regan Udall Foundation for the Food and Drug Administration; Food and Drug Administration; and National Institutes of Health.S.S.O. reported Grants or contracts from National Institute for Drug Abuse (grant number: 4-04-425-0051).S.W.P. reported Grants or contracts from (grants paid to institution): Centers for Medicare and Medicaid Innovation, NICHD, NIMH, NIDA, Boedecker Foundation, RWJF, and consulting fees from RAND Corporation.A.D.W. reported support for the present manuscript: NIH: Funding support through BIRCWH K12 program (5K12HD043483), National Institute on Drug Abuse (K01DA051683);PhRMA Foundation: Fellowship award with salary support to institution; and consulting fees: Tennessee Department of Health; Consulting fees in payment for ongoing COVID-pandemic related SAS programming support—payments directly to the author.C.G.G. reported support for the present manuscript: National Institute on Aging (R01AG043471); grants or contracts from: NIAID, CDC, FDA, Sanofi-Pasteur, Campbell Alliance/Syneos Health; consulting fees: Pfizer, Sanofi, and Merck.M.R.G. reported: grants or contracts from Syneos Health. (Thieme. All rights reserved.)
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