Trends and Characteristics of Opioid Use During Pregnancy Between 2010 and 2023: A French Nationwide Drug Utilization Study.

backgroundWhile opioid use during pregnancy has raised concerns worldwide, population-based data in Europe remain limited. In France, little is known about opioid use in the context of pregnancy.

methodsWe conducted a nationwide drug utilization study using the French EPI-MERES Registry, derived from the National Health Data System (SNDS), including pregnancies ≥ 22 weeks from 2010 to 2023. Exposure to weak and strong opioids was assessed before, during and after pregnancy, and according to calendar years. Exposure characteristics included the number of dispensations, prescriber type and oral morphine equivalents. Maternal sociodemographic and clinical characteristics associated with opioid exposure were analysed using multivariable logistic regression models.

resultsAmong 9.9 million pregnancies, 548,881 (5.5%) were exposed to weak opioids and 12,501 (0.13%) to strong opioids. Weak opioid exposure increased sharply until 2016 (+120%) before stabilizing; diverging trends were observed thereafter: codeine exposure declined to 3.6% in 2023, whereas tramadol exposure continued to rise (+170% during study period) reaching 2.5%. Opioid exposure substantially decreased after conception and remained low throughout pregnancy. Weak opioid prescriptions were not refilled across trimesters in 85%-95% of exposed pregnancies. Opioid exposure was positively associated with maternal socioeconomic deprivation, chronic diseases and psychiatric disorders, with stronger associations observed for strong opioids.

conclusionIn France, opioid use in the context of pregnancy is not infrequent and almost exclusively driven by short-term use of weak opioids. It is strongly associated with maternal vulnerability and low-income status. Although overall opioid exposure stabilized since 2016, the continuous rise in tramadol use warrants further monitoring. SIGNIFICANCE: Population-based evidence on opioid use during pregnancy is scarce in Europe and has been lacking in France. This nationwide study provides the first comprehensive analysis of prescription opioid use in pregnancy in France over a 14-year period, identifying prescribing patterns and populations most likely to be exposed. After a marked increase at the beginning of the study period, overall opioid exposure is stable. In the most recent years, one in 16 pregnant women is exposed to an opioid, almost exclusively a weak opioid, and we observed a sustained rise in tramadol exposure throughout the study period. These findings establish a benchmark for future surveillance.