Studies have already uncovered the dangerous impact on babies when mothers have opioid abuse disorder, and other research has examined the use of opioids to treat opioid abuse disorder. However, Indiana University scientists are now addressing an unanswered question: what about expectant mothers who are prescribed the medications to treat pain? A recent dose of $1.6 million in funding will power a study at IU to peel back the many layers of this question, using a treasure trove of medical records from the other side of the globe.

The team of IU researchers says nearly 50 percent of pregnant women experience moderate to severe pain, and a growing number are being prescribed opioids. Ayesha Sujan, a Ph.D. student at IU’s Department of Psychological and Brain Sciences, notes it’s important to consider potential ripple effects of not treating that pain.

“If a mom is in a lot of pain, it could be that she’s not functioning; she’s not able to take care of her family and herself. And all of those are associated with bad things for the mom and probably the kids—current kids and future kids,” says Sujan, who is part of the research team led by IU Psychological and Brain Sciences Professor Dr. Brian D’Onofrio. “We have to think about what’s the alternative of not taking these medications?”

The study, supported by a $1.22 million National Institute on Drug Abuse grant, will stairstep two critical issues. First, researchers will examine if women who are taking prescribed opioids have adverse pregnancy-related outcomes, such as preterm birth and reduced fetal growth, or if their children have longer-term neurodevelopmental issues, like autism spectrum disorder and attention deficit hyperactivity disorder (ADHD).

Researchers will also tackle a second issue: if there’s evidence of a higher rate of these issues among pregnant women taking prescribed opioids, are they due to the opioid exposure, or a result of other related factors?

“We know women who are in pain probably have a lot of other things going on in their lives,” says Sujan. “Most studies have looked at, ‘Are opioids associated with these bad outcomes?’ But they haven’t really tried to disentangle the question of, ‘Is it the opioid or is it something else in these women’s lives?’ I think that’s an incredibly important question.”

The most obvious “something else” factor is pain; could the pain itself push a mother into premature labor, and not necessarily the prescribed opioid?

“There’s also been a lot of research that shows people who take opioids have a lot of other background risk factors; maybe they tend to have less social support or come from a lower socioeconomic background,” says Sujan. “We know those things are also related to problems down the line, both for the mom and the kids.”

To find the answers, the IU team will comb through medical records in Sweden; the country’s socialized healthcare system produces a massive dataset. Various Swedish databases collect extensive information on each citizen, such as health records and socioeconomic indicators. Each person has unique number—much like a social security number in the U.S.—which enables researchers to link an individual’s health information with a long list of other data points. Sujan says “it’s very, very cool—a whole wealth of information that’s available there.” The Swedish Research Council is providing $400,000 for the study.

Sujan believes peeling back the layers of prescribed opioid use during pregnancy will help doctors and expectant mothers make more informed decisions about using these medications during pregnancy.

“No study in itself can give us the answer to any question, but I think we’re trying to…give a better picture of what are the risks or what aren’t the risks of these medications,” says Sujan. “It’s incredibly important and necessary information for women to know.”

The study will even examine the father’s use of prescribed opioids, which is one example of how a background factor might contribute to outcomes, rather than direct exposure through the mother.

Sujan says extremely robust databases in Sweden will help the research team find new connections.

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