Opioid prescriptions after childbirth linked to increased risk of overdose, persistent use

Women who are prescribed opioids after childbirth have an increased risk of persistent opioid use or other serious opioid-related events, including overdose, in their first year postpartum, according to a new study by Vanderbilt University Medical Center researchers. This is true regardless of whether the woman had a vaginal delivery or a cesarean section. 

The study, published today in Annals of Internal Medicine, followed more than 160,000 pregnant women ages 18-44 enrolled in TennCare who had no history of opioid prescriptions or opioid use disorder within 180 days before their delivery.

Alarmingly, more than half of the women who delivered vaginally and 91% of women who delivered via C-section filled at least one opioid prescription following childbirth. More than 10% of vaginal births and 24% of C-sections also involved filling a second opioid prescription in the postpartum period.

According to Sarah Osmundson, MD, MS, assistant professor of Obstetrics and Gynecology at VUMC and lead investigator for the study, increasing the number of postpartum opioid prescriptions also increased a woman's risk for experiencing a serious opioid-related event, including opioid-related death, persistent use and a diagnosis of opioid use disorder.

"This work highlights serious risks associated with opioid prescribing after childbirth, especially among women who receive multiple prescriptions," said Osmundson. "Routine prescribing after vaginal birth is still common, and it is alarming to know that this may put women at risk of long-term problems with opioids for a procedure (vaginal birth) where opioids have dubious benefit." 

"While prior studies have looked at persistent opioid use after surgery, including C-sections, little attention has been paid to serious opioid-related events following vaginal childbirth, leaving physicians with limited information about the associated risks," added Carlos G. Grijalva, MD, MPH, associate professor of Health Policy and senior investigator for the study. "Current clinical guidelines do not provide clear recommendations for opioid prescribing after childbirth, so this work can help inform practice."

Because the rate of women who receive opioids after vaginal delivery is high in Tennessee and other states, the researchers recommend implementing rational opioid prescribing guidelines to reduce risk and improve outcomes for women in the postpartum period.