The Relationship Between Maternal Nonnarcotic Analgesics Allergy Labels and Maternal and Fetal Outcomes: Results From a Large Administrative Cohort.

Abstract

Nonnarcotic analgesics are the recommended first-line treatment for postpartum pain, and low-dose aspirin is recommended in approximately 85% of pregnant patients who have preeclampsia risk factors. Timely evaluation of nonnarcotic analgesics allergy labels (NNAALs) is essential for high-quality perinatal care. To address a knowledge gap in the relationship between maternal NNAALs and maternal and fetal outcomes. A retrospective analysis was conducted using the Study of Outcomes in Mothers and Infants, a population-based cohort of all births in California between 2016 and 2021. Maternal and fetal outcomes were examined by NNAAL status using Poisson log-linear regression to calculate adjusted relative risks (aRRs), 95% confidence intervals (CIs), and P values adjusted for maternal characteristics. Maternal NNAALs were significantly associated with increased rates of preeclampsia (aRR, 1.16; P < .0001) and eclampsia (aRR, 1.64; P = .0047), cesarean delivery (aRR, 1.2; P < .0001), preterm birth (aRR, 1.17; P < .0001), infants with neonatal intensive care unit admission (aRR, 1.09; P = .0076), neonatal opioid withdrawal syndrome (aRR, 1.49; P < .0001), infant long length of hospital stay (aRR, 1.16; P < .0001), and a decreased rate of infants large for gestational age (aRR, 0.92; P = .0092), but were not associated with infants small for gestational age, major structural birth defects, or 5-minute Apgar score less than 7. Maternal NNAALs were significantly associated with various maternal and fetal adverse outcomes. Our data suggest that proactive evaluations of patients with NNAALs may improve perinatal outcomes.