Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166–$6,067), compared to $4,084 (95% CI: $4,002–$4,166) for nonusers. Conclusion. Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs. 1. Introduction Opioid pain medications are among the most prescribed drugs in the United States (US) [1]. In the past few decades, recent trends in increases in narcotic abuse overshadow successes in improved awareness and management of pain. Clinicians, administrators, and policymakers now face the consequential task of preventing opioid drug misuse and addiction without compromising their effective and appropriate use in the treatment of pain. Opioid dependence in pregnancy complicates the clinical management of an already vulnerable group of patients. Dependence increases the risk of poor maternal and perinatal outcomes [2–11]. Women of reproductive age who use and abuse opioid drugs, both prescription and illegal, are more likely to have a lower socioeconomic status, family instability, receive inadequate prenatal care, and suffer from alcohol, tobacco, and illicit drug use [12, 13]. In addition to the risks associated with opioid dependence, these comorbid conditions further increase the risk of adverse perinatal outcomes [3, 14]. Increasing at an alarming rate, opioid use in pregnancy underwent an estimated 3-4-fold increase between 2000 and 2009 [15, 16]. The 2011 National
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