TOPLINE:

Women who received opioids — especially tramadol — around childbirth had an increased likelihood of continuing to use them after childbirth, with an even greater increase in the risk among those who had not used opioids before pregnancy.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to examine whether women exposed to opioids in childbirth continued using the drugs postpartum.
• They reviewed data related to Medicaid claims from Pennsylvania between 2015 and 2021 and included 172,839 live births to women aged 19-50 years (mean age at delivery, 26.9 years).
• The analysis captured filled prescriptions for opioids during the childbirth period, defined as 7 days before delivery through 2 months postpartum. Prescribed opioids included oxycodone, tramadol, morphine, and other combinations.
• The primary outcome was persistent use of opioids postpartum, defined as either a diagnosis of opioid use disorder in the postpartum year or filled opioid prescriptions in two or more separate calendar quarters between 3 and 14 months postpartum.

TAKEAWAY:

• Overall, 25% of women filled an opioid prescription during the childbirth period, and 5.7% continued use of opioids postpartum.
• Women exposed to opioids during the childbirth period were 88% more likely to use opioids persistently postpartum than those unexposed (adjusted odds ratio [aOR], 1.88; 95% CI, 1.79-1.96).
• Exposure to tramadol was linked to the highest odds of persistent use of opioids postpartum compared with exposure to oxycodone (aOR, 4.58; 95% CI, 3.87-5.43).

IN PRACTICE:

“The findings urge attention to clinical practice guidelines grounded in equity that balance effective postpartum pain management while minimizing opioid-related risks and underscore the importance of postpartum care coordination models,” the authors of the study wrote.

SOURCE:

This study was led by Meredith Matone, DrPH, MHS, affiliated with Children’s Hospital of Philadelphia and University of Pennsylvania in Philadelphia. It was published online on November 20, 2025, in Obstetrics & Gynecology.

LIMITATIONS:

This study relied on filled prescription claims and not actual use of opioids. Exposure to opioids 1 year prior to pregnancy was not accounted for. Researchers excluded patients with cancer or sickle cell disease, and the findings may not apply to those with private or no insurance.

DISCLOSURES:

This study received funding from the National Institute for Health Care Management Research and Educational Foundation. The authors reported having no conflicts of interest.

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