Abstract
Introduction
Opioids are commonly prescribed to manage postpartum pain. Yet, 1.7%–2.2% of postpartum people develop new persistent use of opioids after receiving a postpartum opioid prescription. Individuals who experience opioid misuse often have mental health comorbidities. A common mental health condition among pregnant individuals is depression. Information about the association between prenatal depression and persistent opioid use postpartum could guide shared decision-making during counseling, but most available studies rely on insurance claims data, which do not capture non-prescribed opioids. In this study, we examined the association between prenatal depression and persistent postpartum opioid use in selected US states.
Methods
We used data from the 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) Core Questionnaire, Opioid Supplement, and Opioid Call Back Survey from six states (Kentucky, Louisiana, Massachusetts, Missouri, Pennsylvania, and Utah) to examine the association between prenatal depression and persistent postpartum opioid use (defined as postpartum opioid use for 4 weeks or more) in the United States. The survey captured postpartum use of pharmaceutical opioids, including those prescribed to the respondent and those prescribed to another individual. Unadjusted and adjusted logistic regression models were used to assess the association among postpartum individuals. We calculated marginal effects and presented the study results as percentage point differences with 95% CIs. All models used PRAMS survey weights.
Results
A total of 1680 individuals were included in the study, corresponding to 154,878 birthing people in the United States. Of these individuals, the prevalence of prenatal depression was 18.2%. Among those with prenatal depression, 12.3% (95% CI: 7.3, 20.1) of individuals had persistent postpartum opioid use compared to 3.3% (95% CI: 2.3, 4.7) among individuals without prenatal depression (p < 0.001). After adjusting for age group, race/ethnicity, educational level, cesarean delivery, and preterm birth, prenatal depression was associated with a 6.6-percentage-point (95% CI: 1.9, 11.3) increase in persistent postpartum opioid use.
Conclusion
Individuals with depression during pregnancy were more likely to develop persistent postpartum opioid use. Recognizing the relationship between prenatal depression and persistent postpartum opioid use may help tailor postpartum pain management and counseling strategies.