Opioid Use During Pregnancy Among Individuals With Disabilities.

Abstract

The aim of this study was to investigate (1) prevalence and time trends in opioid use during pregnancy and (2) patterns of opioid use before and during pregnancy among individuals with and without disabilities. This population-based cohort study in Ontario, Canada, included all pregnancies to individuals with physical only (n=133,371), sensory only (n=49,306), intellectual/developmental-only (n=2,876), and multiple (n=11,195) disabilities and those without any disability (n=1,271,919) in 2013-2021. Overall and annual prevalence of opioid use during pregnancy was estimated, and patterns of opioid use by type, timing, duration, and dose before and during pregnancy were described. Data were analyzed from 2024-2025. Opioid use during pregnancy was more common among individuals with multiple (10.5%), intellectual/developmental (8.9%), and physical (8.3%) disabilities and similar in those with sensory disabilities (4.9%), compared with those with no disability (3.9%). From 2013 to 2021, prevalence decreased in individuals without a disability (4.6% to 3.0%) and among those with multiple (10.5% to 8.7%), intellectual/developmental (10.6% to 8.3%), physical (9.8% to 5.9%), and sensory (5.7% to 3.2%) disabilities. Short-term prescribed opioid use for pain was the most prevalent type used. Prevalence of prescribed opioid use was highest 6 months before conception and decreased in the first trimester in all groups but remained higher among individuals with disabilities. Duration and dose were higher in individuals with disabilities than in those without disabilities. Maternal disability was associated with greater use, longer duration, and higher dosages of opioids during pregnancy. This group could benefit from enhanced evidence-based preconception care, medication counseling, and nonpharmacologic pain management, where possible.