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To investigate (1) prevalence and time trends in opioid use during pregnancy and (2) patterns of opioid use before and during pregnancy, among individuals with and without disabilities.

This population-based cohort study in Ontario, Canada, included all pregnancies to individuals with physical only (N=133,371), sensory only (N=49,306), intellectual/developmental only (N=2,876), and multiple disabilities (N=11,195), and those without any disability (N=1,271,919), 2013-2021. Overall and annual prevalence of opioid use during pregnancy was estimated, and patterns of opioid use by type, timing, duration, and dose before and during pregnancy were described. Data were analyzed from 2024-2025.

Opioid use during pregnancy was more common among individuals with multiple (10.5%), intellectual/developmental (8.9%), and physical disabilities (8.3%), and similar in those with sensory disabilities (4.9%), compared with no disability (3.9%). From 2013-2021, prevalence decreased in individuals without a disability (4.6% to 3.0%), and among those with multiple (10.5% to 8.7%), intellectual/developmental (10.6% to 8.3%), physical (9.8% to 5.9%), and sensory (5.7% to 3.2%) disabilities. Short-term prescribed opioid use for pain was the most prevalent type used. Prevalence of prescribed opioid use was highest at 6 months preconception and decreased in the first trimester in all groups but remained higher among individuals with disabilities. Duration and dose were higher in individuals with disabilities compared to those without disabilities.

Maternal disability was associated with higher use, longer duration, and higher dosages of opioids during pregnancy. This group could benefit from enhanced evidence-based preconception care, medication counseling, and non-pharmacologic pain management, where possible.