Opioid prescribing in pregnancy increased in Catalonia from 2011 to 2020

Photo by Logan Voss / Unsplash

Frontiers in Medicine Published April 22, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider that opioid prescribing in pregnancy increased in Catalonia, with most exposures involving weak opioids.

This retrospective drug-utilization cohort study used the SIDIAP database, covering 75% of the Catalan population, to analyze opioid prescribing patterns among 41,398 pregnancies in women aged 12–50 years from April 2011 to March 2020. The primary exposure was at least one opioid prescription during pregnancy, with pregnancies not exposed to opioids as the comparator.

The main result was that 998 out of 41,398 pregnancies (2.41%) involved opioid exposure. Opioid prescribing increased over the study period. Among exposed pregnancies, 96.39% involved weak opioids. In over one-third of cases, opioid exposure exceeded 30 days.

Safety and tolerability outcomes were not reported. The study did not report adverse events, serious adverse events, or discontinuations.

Key limitations include the observational design, which cannot establish causality, and the lack of reported p-values or confidence intervals. The study did not report pregnancy outcomes as a primary result.

The practice relevance underscores the need for pregnancy-specific pain management guidelines and stricter adherence to existing recommendations, based on these prescribing patterns.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundThe increasing use of opioids during pregnancy and their potential adverse effects on fetal development have raised public health concerns. This study aimed to investigate the opioid prescribing patterns among pregnant women in Catalonia, Spain.Materials and MethodsA retrospective drug-utilization study was conducted using the Information System for Research in Primary Care (SIDIAP) database, covering 75% of the Catalan population. Pregnancies in women aged 12–50 years between April 2011 and March 2020 were included. Opioid exposure was defined as at least one opioid prescription during pregnancy and was estimated through prevalence and cumulative incidence in pregnancy episodes and by trimester. We also examined pregnancy outcomes, exposure duration, and the use of non-opioid analgesics prior and concomitant to opioid therapy.ResultsAmong 41,398 pregnancies, 998 (2.41%) were exposed to prescribed opioids. Opioid prescribing increased over time, particularly since 2013 and mainly for non-cancer pain. Most exposures involved weak opioids (96.39%), with tramadol being the most frequently prescribed. Paracetamol use before or during opioid treatment was common, while NSAID use was less frequent. In over one-third of cases, opioid exposure exceeded 30 days, with even longer durations for those exposed to strong opioids.ConclusionOur findings show a rise in opioid prescribing among pregnant women in Catalonia, primarily for non-cancer pain. Contradicting current guidelines, opioids were often prescribed without prior or concurrent NSAID use and with extended exposure durations. This underscores the need for pregnancy-specific pain management guidelines and stricter adherence to existing recommendations to minimize potential risks to the fetus.