(279) Opioid Use in Pregnancy in Women with Disabilities

Background: Approximately 1 in 2 reproductive-aged women with a disability used an opioid in the past year. However, little is known about opioid use in pregnancy among women with disabilities, irrespective of pregnancy outcome.

Objectives: To investigate (1) time trends in the prevalence of opioid use in pregnancy and (2) patterns of opioid use before and during pregnancy, among women with and without disabilities.

Methods: We conducted a population-based cohort study in Ontario, Canada, including pregnancies conceived in 2013-2021 to women with physical (N=133,371), sensory (N=49,306), intellectual/developmental (N=2,876), and multiple disabilities (N=11,195), and those without a disability (N=1,271,919). Using multiple linked health administrative databases, we estimated the annual prevalence of opioid use during pregnancy, and described patterns of opioid use by type, timing, duration, and dose before and during pregnancy.

Results: Overall, opioid use in pregnancy was more common among women with multiple (10.5%), intellectual/developmental (8.9%), physical (8.3%), and sensory disabilities (4.9%) compared with those without a disability (3.9%). From 2013-2021, the prevalence of opioid use decreased among women without a disability (4.6%-3.0%), and among those with multiple (10.5%-8.7%), intellectual/developmental (10.6%-8.3%), physical (9.8%-5.9%), and sensory (5.7%-3.2%) disabilities. Opioid analgesic use <30 days was the most prevalent type of opioid used in all groups. The prevalence of opioid use was highest 6 months preconception and decreased by over half in the first trimester in all groups, but remained higher among women with vs. without disabilities at each timepoint. Duration and dose tended to be higher in women with multiple, physical, and intellectual/developmental disabilities compared to women without disabilities.

Conclusion: Accessible and inclusive reproductive health education and medication management are needed to support informed decision-making and reduce health inequities in women with disabilities.