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TOPLINE:

Maternal nonnarcotic analgesic allergy labels (NNAALs) were linked to a more than 60% higher risk for eclampsia and a nearly 20% higher risk for preterm birth. Infants born to individuals with NNAALs faced a nearly 50% higher risk for neonatal opioid withdrawal syndrome and longer hospital stays.

METHODOLOGY:

• Researchers conducted a retrospective analysis using the Study of Outcomes in Mothers and Infants, a population-based cohort of all births in California between 2016 and 2021, with a total of 2,244,210 singleton live births with linked maternal-fetal records included in the analysis.
• Maternal NNAALs were identified using International Classification of Diseases, 10th Revision (ICD-10) code Z88.6 from hospital discharge, emergency department, and ambulatory surgery records for individuals with an encounter between the first day of the last menstrual period and the date of the infant’s birth.
• Maternal and fetal outcomes examined included preeclampsia or eclampsia, preterm birth (subdivided as < 32 weeks, 32 to < 37 weeks, and any < 37 weeks), cesarean delivery, small for gestational age, large for gestational age, neonatal ICU (NICU) admission, major birth defects, infant length of hospital stay, 5-minute Apgar score < 7, and neonatal opioid withdrawal syndrome.
• Analysis utilized Poisson log-linear regression to calculate relative risks (RRs), adjusted RRs (aRRs), 95% CIs, and P values adjusted for maternal characteristics including age, payer, parity, race or ethnicity, country of birth, prepregnancy BMI, county of residence, asthma, urticaria, chronic rhinosinusitis, chronic kidney disease, autoimmune disorders, preexisting hypertension, preexisting diabetes, smoking, drug or alcohol use, depression, and year of birth.
• Of the 2,244,210 singleton births analyzed, 10,460 (0.47%) infants were born to individuals with documented NNAALs, whereas 2,233,750 served as the referent group without documented analgesic allergies.

TAKEAWAY:

• Maternal NNAALs were associated with increased rates of preeclampsia (aRR, 1.16; 95% CI, 1.08-1.25; P < .0001) and eclampsia (aRR, 1.64; 95% CI, 1.17-2.33; P = .0047) after adjusting for maternal characteristics.
• Individuals with NNAALs had higher rates of cesarean delivery (aRR, 1.2; 95% CI, 1.16-1.24; P < .0001) and preterm delivery at 32-36 weeks (aRR, 1.18; 95% CI, 1.11-1.26; P < .0001) or any < 37 weeks (aRR, 1.17; 95% CI, 1.11-1.24; P < .0001).
• Infants born to individuals with NNAALs were more likely to have NICU admission (aRR, 1.09; 95% CI, 1.02-1.16; P = .0076), neonatal opioid withdrawal syndrome (aRR, 1.49; 95% CI, 1.22-1.81; P < .0001), and a long length of hospital stay (aRR, 1.16; 95% CI, 1.11-1.21; P < .0001).
• After adjusting for maternal characteristics, infants born to individuals with NNAALs were less likely to be large for gestational age (aRR, 0.92; 95% CI, 0.87-0.98; P = .0092), but no significant associations were found for small for gestational age, major structural birth defects, or 5-minute Apgar score < 7.

IN PRACTICE:

“Maternal NNAALs were significantly associated with various maternal and infant adverse outcomes. Our data suggest that proactive evaluations of patients with NNAALs may improve perinatal outcomes,” wrote the authors of the study.

SOURCE:

The study was led by Chang Su, MD, University of California San Francisco Medical Center, and Christina Chambers, PhD, MPH, University of California San Diego. It was published online in The Journal of Allergy and Clinical Immunology: In Practice.

LIMITATIONS:

The primary limitation is the retrospective observational study design using an administrative cohort, which is associated with unmeasured confounding that may limit clinical significance even when outcomes are statistically different. The patient population was stratified by ICD-10 code Z88.6, which was assumed to represent nonnarcotic analgesic allergy, and the false-positive or false-negative rates of NNAALs could not be estimated. The prevalence of nonnarcotic analgesic allergy was likely underestimated (0.47% in this study vs 2%-3% reported in previous studies) due to potential misclassification of individuals without the ICD-10 code in their birth records. For individuals with ICD-10 Z88.6, the reaction history and specific agent to which the patient was allergic were not available, and medication administration information was unavailable to verify aspirin use during pregnancy or analgesic choice during delivery. Comorbidities based on ICD-10 codes associated with emergency room visits and hospitalizations may be underascertained, and no correction for multiple comparisons was performed.

DISCLOSURES:

No funding sources were reported for this study. Su disclosed receiving funding from the Allergists’ Foundation Community Grant Program for an unrelated project. Michael Schatz disclosed receiving research grant support from Sanofi and honoraria from UpToDate.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.