A new study from researchers at the University of Iowa shows that mothers diagnosed with postpartum depression and having undergone a Cesarean section are five times more likely to fill at least two opioid prescriptions in the three months following labor than are mothers without those conditions.

Kelli Ryckman, associate professor of epidemiology at the University of Iowa College of Public Health, led the study, which was conducted by members of the Iowa Perinatal Health Research Collaborative.

“There’s been a lot of talk about the opioid crisis, but mothers who have delivered and get opioids for pain are underrepresented in the discussion about opioid misuse,” Ryckman says. “Yet they are at increased risk.”

Ryckman and her colleagues looked at the information available in a statewide insurance claims database managed by the University of Iowa Center for Public Health Statistics. All the records in the database are stripped of identifying information to protect the subjects’ privacy. From there, they carved out a cohort of 19,000 mothers who gave birth in Iowa between 2004 and 2015.

By matching a patient’s depression diagnosis with that patient’s pharmacy claims, the researchers looked at the relationship between maternal depression and the number of opioid prescription fills.

The findings — which will be presented during a February 2019 meeting of the Society of Maternal-Fetal Medicine — include:

• Nearly 44 percent of the women in the cohort had at least one opioid prescription, and 12 percent had at least two prescription fills from the time of delivery until three months postpartum.
• Women with a history of depression had about 1.6 greater odds of having an opioid fill and about a two times greater risk of having at least two opioid fills compared to women without a depression history.
• Women who had a Cesarean section and had postpartum depression were five times more likely to fill at least two opioid prescriptions in the first three months after delivery.

“We suggest there is universal screening for perinatal depression that can identify women with probable depression who are at an increased risk for opioid misuse or opioid-related maternal mortality,” Ryckman says.