How Opioid Use Impacts Pregnancy

Opioid use in women may result in trouble conceiving and sustaining a pregnancy, the results of a new study indicate.¹

The researchers analyzed data from 1228 women aged between 18 and 40 years who participated in the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial. All participants had a history of 1 or 2 previous pregnancy losses.

Of the total participants, 226 (18%) women used opioids before or while trying to conceive. The results indicated that opioid use before conception was associated with a 29% lower chance of becoming pregnant. In addition, of the 685 women who became pregnant, only 33 (5%) had used opioids in early pregnancy. These women were found to be 1.5 times more likely to have a miscarriage than women who had not used opioids in the early weeks of pregnancy.

Consultant360 spoke with lead author Kerry Flannagan, PhD, who is a postdoctoral researcher in the Division of Intramural Population Health Research at the National Institute of Child Health and Human Development, about the study’s findings and their implications.

Consultant360: Your study found that opioid use results in problems conceiving and sustaining a pregnancy. Did you anticipate these findings, or did they surprise you?

Kerry Flannagan: We know from previous studies that opioid medications have effects on reproductive hormones and that opioid misuse during pregnancy is related to several adverse outcomes, including pregnancy loss. So, we hypothesized that even infrequent use may be related to problems with conceiving and sustaining a pregnancy.

CON360: What alternatives for opioids for pain management would you suggest for women who are pregnant or want to become pregnant, after seeing the results of this study? How will these findings affect clinical practice?

KF: Women and their health care providers should work together to examine the risks and benefits of opioid use, including potential reproductive complications as highlighted by our results, as well as the array of other pain management strategies that are available when determining appropriate pain management for women who wish to become pregnant.

CON360: What are the key clinical takeaways of this study? How do you suggest obstetricians, gynecologists, and primary care physicians implement these key takeaways into their everyday practice?

KF: The key clinical takeaway of this study is that even limited, nonchronic opioid use before conception and during early pregnancy is associated with lower odds of becoming pregnant and higher risk of pregnancy loss. Physicians should consider these results when discussing treatment for pain with patients, since they represent considerations that may be relevant to women who wish to become pregnant.

CON360: Your study calls for further research on how opioid use affects fertility and early pregnancy. What knowledge gaps still exist in this area?

KF: One major gap is that we do not know how the reproductive effects of opioid use differ by type of opioid medication, dose, or duration of use. It is also important to study associations of opioid use with fertility and pregnancy among women undergoing fertility treatments, since these medications are used to manage pain after procedures such as egg retrieval for in-vitro fertilization. Additionally, although we know that chronic opioid use affects reproductive hormone levels in men, there is very little research on whether opioid use among men could also be related to a couple’s chances of successful pregnancy.

Reference:

1. Flannagan KS, Mumford SL, Sjaarda LA, et al. Is opioid use safe in women trying to conceive? Epidemiology. Published online August 3, 2020. Doi: 10.1097/EDE.0000000000001247