Year of Publication

2019

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Kathleen Winter

Committee Member

Dr. April Young

Committee Member

Dr. Emily Slade

Abstract

Background: The prevalence of opioid use in pregnancy has increased sharply in recent years. Kentucky is one of the hardest hits states and has seen many babies born with withdrawal symptoms over the past decade. Recent years have seen an increase in efforts to decrease opioid use in both inpatient and outpatient settings. However, Kentucky continues to have high rates of opioid prescription. This study aims at looking at trends in Opioid Use Disorder (OUD) in pregnancy, Neonatal Opioid Withdrawal Syndrome(NOWS) and the use of opioids during delivery hospitalization at a Kentucky tertiary institution.

Methods- Data on all deliveries between Jan 1st, 2013 and December 31st, 2017 were obtained from University of Kentucky Health Care. Information on a total of 8,999 individual deliveries were included in the dataset. Using Cochrane-Armitage tests first and then logistic regression, the data were analyzed for trends in OUD, NOWS and the administration of opioids during delivery hospitalization.

Results- An increase in prevalence of OUD in pregnancy (p <0.0001) and NOWS(p=0.007) was observed over the study period. No significant trend was observed in the use of opioids during vaginal delivery hospitalizations(p=0.07). Among women who delivered vaginally, advancing maternal age was associated with slightly lower odds of inpatient opioid administration while tobacco use (OR=1.33, CI=1.04, 1.69), lower county income quartile (OR= 1.90, CI=1.09, 3.29) and unmarried status (OR=1.40, CI=1.16, 1.69) were significantly associated with higher odds of inpatient opioid administration.

Conclusion- The findings of significant increases in NOWS over the years highlight the need for better family planning services targeted towards people of reproductive age with opioid use disorder. Better opioid stewardship is required to substantially reduce therapeutic opioid use.

Available for download on Sunday, August 09, 2020

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