Opioid use during pregnancy: An analysis of comment data from the 2016 Pregnancy Risk Assessment Monitoring System survey

ABTSTRACT

Background: Opioid misuse during pregnancy has been associated with adverse infant outcomes including preterm birth, stillbirth, and neonatal opioid withdrawal syndrome. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an on-going state-based surveillance system of maternal behaviors, attitudes, and experiences prior to, during, and after pregnancy. Methods: We analyzed qualitative comments related to opioid use during pregnancy collected in 2016 from an open-ended prompt at the end of the PRAMS survey in 35 states (N = 40,408). Key word searches were conducted on the open-ended responses (n = 9,549) to identify opioid-related content with an automated function using Microsoft Excel. All responses from the initial screening (n = 1,035) were manually reviewed, and 69 responses were confirmed to relate to the respondent’s personal experience with opioid use during pregnancy. Content analysis was conducted by 3 independent coders; key themes were compiled, discussed, and finalized by the coding team. Results: Five key themes related to opioid use during pregnancy were identified: (1) gratitude for treatment, recovery, and healthy infants; (2) pregnancy as motivation to seek treatment; (3) difficulty finding prenatal care providers with training in substance use disorders; (4) concern about the effects of treatment on the infant; and (5) experiences of discrimination and stigma in the hospital around the time of delivery. Conclusions: Women may be aware of the potential impact of opioid use during pregnancy on the health of their infants and motivated to seek treatment. Findings may help inform new and ongoing initiatives designed to improve care and reduce stigma for women needing or seeking treatment.

Keywords:

• PRAMS
• qualitative data
• opioids
• pregnancy
• stigma

Acknowledgments

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors acknowledge Dr. Jean Ko for her input and review of the first draft of the manuscript and the PRAMS Working Group: Kristen Johnson, Alabama Department of Public Health; Enid Quintana-Torres, Arizona Department of Health Services; Ashley Juhl, Colorado Department of Public Health & Environment; Jennifer Morin, Connecticut Department of Public Health; Fern Johnson-Clarke, District of Columbia Department of Health; Jerri Foreman, Florida Department of Health; J. Michael Bryan, Georgia Department of Public Health; Joyce Prince, Illinois Department of Public Health; Brittany Reynolds, Indiana State Department of Health; Jennifer Pham, Iowa Department of Public Health; Lisa Williams, Kansas Department of Health and Environment; Tracey Jewell, Kentucky Department for Public Health; Rosaria Trichilo, Louisiana Department of Health; Laurie Kettinger, Maryland Department of Health; Emily Lu, Massachusetts Department of Public Health; Rebecca Lander, Missouri Department of Health and Senior Services; Tami Conn, Nevada Department of Health and Human Services; Sara Riordan, NH Department of Health & Human Services; Anne Radigan, New York State Department of Health; Grace Njau, North Dakota Department of Health; Tina Kent, Oregon Department of Human Services; Sara E. Thuma, Pennsylvania Department of Health; Wanda Hernández Virella, Puerto Rico Department of Health; Karine Monteiro, Rhode Island Department of Health; Harley T. Davis, South Carolina Department of Health and Environmental Control; Linda Ahrendt, South Dakota State Department of Health; Uvonne Leverett, Tennessee Department of Health; Barbara Algarin, Utah Department of Health; John Davy, Vermont Department of Health; Linda Lohdefinck, Washington Department of Health; Monica Pegram, West Virginia Bureau for Public Health; Lorie Wayne Chesnut, Wyoming Department of Health.

Author contributions

Megan O’Connor and Michaila Czarnik designed the study. Brian Morrow extracted data, performed all descriptive statistics and constructed the tables. Megan O’Connor, Michaila Czarnik, and Denise D’Angelo analyzed and coded all qualitative data, identified themes, interpreted findings, and drafted the manuscript. All authors have reviewed and approved the final manuscript.