(270) Concomitant Periconceptional Opioid Medication, Alcohol, and Tobacco Use

Background: Data on opioid medication use concomitant with other substances among pregnant women are limited.

Objectives: To describe rates of periconceptional opioid medication use alone or concomitantly with alcohol and/or tobacco use among control participants in the National Birth Defects Prevention Study (NBDPS; 1997-2011) and Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS; 2014-2019).

Methods: Mothers of liveborn infants without major birth defects (n=12,927) from two U.S. multicenter, population-based, case-control studies (NBDPS and BD-STEPS) self-reported periconceptional opioid medication, alcohol, and tobacco use (from the month before conception to the third month of pregnancy). In the combined cohort, we compared maternal characteristics (age, race/ethnicity, education, pre-pregnancy BMI, and prior live birth), study site, opioid type, and illicit drug use (1997-2011 only) of control participants reporting opioid medication use alone versus concomitantly with alcohol and/or tobacco. Difference ≥5 percentage points was considered meaningful.

Results: During 1997-2019, 2.2% (n=287) of control participants reported periconceptional opioid medication use, of whom 37.6% (n=108) reported opioid use alone (without tobacco or alcohol) and 62.4% (n=179) reported opioid and alcohol and/or tobacco use concomitantly. Comparing women who reported concomitant alcohol or tobacco use to opioid medication use alone, a higher percentage were non-Hispanic White (78.2% vs. 68.5%) and a lower percentage reported more than one prior live birth (30.2% vs. 38.3%). During 1997-2011, women reporting concomitant alcohol or tobacco use more frequently reported illicit drug use (22.5% [34/151]) compared to those using opioid medications alone (3.2% [3/93]).

Conclusions: Approximately two-thirds of women who reported periconceptional opioid medication use also reported alcohol and/or tobacco use. Future studies will assess birth defect risks associated with combined exposures.