The perinatal pharmacoepidemiology team in the Department, which includes Professors Carlos Grijalva, MD and Marie Griffin, MD, Research Associate Professor Margaret Adgent, PhD, Assistant Professor Ashley Leech, PhD, and Assistant Professor Andrew Wiese Ph.D., MPH have worked closely with colleagues in the Department of Obstetrics and Gynecology to use linked records of mothers and babies enrolled in TennCare, Tennessee’s Medicaid program, to examine important questions regarding maternal and infant outcomes associated with medication use during pregnancy.
The research team has conducted several studies in recent years to inform patients and providers regarding appropriate pain management standards during and after birth. A collection of impactful studies highlighted the substantially increased risk of opioid dependency, opioid use disorder and death associated with postpartum opioid prescribing, especially for those using high-dose postpartum opioids.
Their findings emphasize the need for judicious prescribing of opioids following all deliveries, as the rates were similarly high among women with vaginal or cesarean delivery. These findings are already informing clinical practice via UpToDate, an evidence-based clinical decision support service.
Ongoing and future work by the perinatal pharmacoepidemiology team also seeks to understand the impact of certain social determinants of health, including social vulnerability, on the initiation and adherence to pharmacotherapy for gestational diabetes mellitus, as well as the risk of maternal and infant harms associated with pharmacotherapy for epilepsy during pregnancy.
In the last 10 years, Drs. Griffin, Grijalva and Wiese have also used these data, in addition to other surveillance and administrative databases to fully characterize the impact of pneumococcal conjugate vaccine introduction into the US childhood immunization program. In a series of studies with colleagues in the Departments of Pediatrics, Medicine, and Biostatistics, their work helped to demonstrate reductions in childhood empyema, acute otitis media episodes and antibiotic use associated with pneumococcal conjugate vaccine introduction, as well as to characterize ongoing racial and sex disparities in childhood diseases caused by Streptococcus pneumoniae.