ASRM 2019 — Even limited opioid use may adversely affect reproduction

  • Daniel M. Keller, Ph.D
  • Conference Reports
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  • Even limited, nondependent opioid use in the pre- and periconception period can adversely affect fecundability and may increase risk for pregnancy loss in the periconception period.

Why this matters

  • Prescription opioid use has increased among reproductive-age women.
  • Although use during pregnancy is known to have adverse outcomes, the risks of limited opioid use in the preconception and early pregnancy periods have been unclear.

Study design

  • Prospective cohort of 1228 women from the Effects of Aspirin in Gestation and Reproduction Study.
  • Women with 1-2 prior pregnancy losses randomly assigned to preconception low-dose aspirin or placebo.
  • Measured urinary opioid concentrations in the preconception period and at 4 and 8 weeks of pregnancy for women who became pregnant.
  • Women self-reported opioid use.
  • Study supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Key results

  • Preconception use: positive urine, 9.0%; self-reported use, 13.6%; urine or self-reported, 19.8%.
  • Positive urine at week 4 or 8: 33/683 pregnancies (4.8%).
  • Use among opioid users: once, 79%; twice, 15%; 3-4 times, 6%.
  • Most common self-reported opioids: hydrocodone, 53%; oxycodone, 29%.
  • Only combining urine detection and self-reported use before conception showed lowered fecundability: OR, 0.76 (95% CI, 0.61-0.94).
  • Only positive urine measurement increased risk ratio (RR) of pregnancy loss: use at week 4 of pregnancy, RR, 2.10 (95% CI, 1.08-4.08); at week 4 or 8, RR, 2.60 (95% CI, 1.32-5.12).
  • No effect of opioid use on live births.


  • Potential bias and/or recall error in self-reported use
  • Outcomes not correlated with specific opioids