Are pregnant women with disability prescribed opioids more and at higher dosages than those without disability?: A retrospective cohort study of South Carolina Medicaid beneficiaries

Background: Nationally, individuals with disability have higher rates of opioid use and misuse and are prescribed higher doses than those without disability. Opioid prescriptions during pregnancy are associated with adverse birth outcomes.

Objective: To understand the difference in opioid prescribing during pregnancy over time by disability status among Medicaid beneficiaries who gave birth from 2008 to 2017 in South Carolina.

Methods: Data from hospital discharges, vital records, and pharmacy were linked to determine the mother's disability status, opioid prescriptions filled during pregnancy, and other maternal characteristics. Disability status was characterized into physical disability, inflammatory conditions, intellectual and developmental disabilities (IDD), and psychiatric conditions. Bivariate analyses and negative binomial regression were utilized to obtain adjusted rate ratios for total opioid prescriptions and total morphine milligram equivalents (MME) during pregnancy per live birth. Models were adjusted for chronic pain status. The final analytic sample included 319,752 births to 224,838 mothers.

Results: Almost 7% of the births were to mothers with at least one type of disability. Overall, those with disability had a significantly higher adjusted rate ratio of total opioid prescriptions (aRR: 2.36; 95% CI: 2.21-2.52) and total MME (aRR: 2.29; 95% CI: 2.07-2.52) during pregnancy per live birth than those without disability. These findings were seen across all the diagnostic groups, except IDD, where there were no significant differences.

Conclusions: The current study found that women with physical, inflammatory, and psychiatric disability were prescribed more opioids and at higher dosages during pregnancy than their counterparts without disability, after adjusting for chronic pain status.