Using pregnancy risk assessment monitoring system data to investigate prescription drug use during pregnancy in Hawaiʻi

Abstract

Both legal and illicit use of prescription drugs during pregnancy is thought to be increasingly common in the state of Hawaiʻi, based on trends demonstrated elsewhere in the country and throughout the world. Prescription opioids, along with antianxiety and antidepressant medications are of special concern, both for their prevalence and for the potential risks associated with using these drugs during pregnancy. The purpose of this dissertation is to investigate prescription drug use during pregnancy in Hawaiʻi, with a focus on opioids and antianxiety and antidepressant medications. The first of three studies sought to determine the prevalence of prescription opioid drug use during pregnancy in Hawaiʻi, describe differences in prescription opioid drug use during pregnancy in Hawaiʻi by maternal demographic characteristics, and investigate possible predictors of prescription opioid drug use during pregnancy through the use of multivariable logistic regression. The second study aimed to determine whether prescription opioid use during pregnancy was associated with poorer birth outcomes among users when compared to non-users in Hawaiʻi; specifically focusing on associations between prescription opioid use during pregnancy and risk of small for gestational age, preterm, or low birth weight deliveries among women giving birth to live, singleton infants in Hawaiʻi. Study three attempted to describe the under-studied topics of anxiety and depression before, during, and after pregnancy, along with related help-seeking behaviors and treatment strategies, for which there is a scarcity of information in Hawaiʻi. Findings from the three studies covered in this dissertation confirm that use of prescription opioids and antianxiety and antidepressant medications is relatively common during pregnancy in Hawaiʻi. They also provide more detailed information on usage patterns, differences by demographic characteristics, and associated risk factors and birth and maternal health outcomes. All three also provide suggestions for future research avenues in order to more fully understand the complete landscape of prescription drug use during pregnancy in Hawaiʻi.