Daily Dose: Maternal Opioid Treatment Postpartum & Risk of Adverse Infant Outcomes

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On April 3, 2023, we reported on a study published in The BMJ that examined whether postpartum maternal opioid treatment is associated with short-term increased risk of adverse outcomes in infants.

The study

Researchers analyzed 8 years of health care data obtained from the ICES MOMBABY database, which links children born in Ontario hospitals to their mothers. They also used the Narcotics Monitoring System and the National Ambulatory Care Reporting System databases to identify prescriptions for postpartum opioids. Participants included 865 691 mother-infant pairs discharged from the hospital within 7 days of delivery between September 1, 2012, and March 31, 2020. Researchers identified 85 852 mothers who had filled an opioid prescription between delivery and up to 7 days after being discharged from the hospital. Each mother who filled an opioid prescription was propensity score matched to one who did not fill an opioid prescription. Opioids prescribed included oxycodone, codeine, morphine, and hydromorphone, with an average supply of 3 days.

The primary outcome was hospital readmission of infants for any reason within 30 days of their mother filling an opioid prescription. Secondary outcomes included any emergency department visit, hospital admission for any injury, admission to the neonatal intensive care unit, hospital admission with resuscitation or assisted ventilation, and all-cause death.

The results

Of the infants admitted to the hospital within 30 days of birth, 2962 (3.5%) were born to mothers who filled an opioid prescription and 3038 (3.5%) were born to mothers who did not fill an opioid prescription.

Infants of mothers who were prescribed an opioid were more likely to be admitted to the hospital for any reason than infants of mothers who were not prescribed an opioid (hazard ratio [HR] 0.98, 95% CI 0.93-1.03) and slightly more likely to be taken to an emergency department in the subsequent 30 days (HR 1.04, 95% CI 1.01-1.08). There were no differences between the 2 groups in all other secondary outcomes, and no deaths occurred in either group.

Note from authors

"This study found no association between maternal opioid prescription after delivery and several adverse infant outcomes, including death. Although we endorse caution in short term postpartum opioid use in selected mothers, clinicians and parents should be reassured that infants are at low risk of harm."

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