(99) Prenatal Opioid Use: High Stakes Game In Need of a Team Approach

Background: Since data first became available in 2014, Montgomery County has experienced the highest rates of OUD and unintended overdose deaths in the state. As the prevalence of OUD has increased, so too has the rate of OUD in pregnancy (POUD). Numerous investigators have highlighted the need to integrate opioid use disorder (OUD) treatment, including opioid agonist treatment (OAT), with maternity care. However, few providers are trained in both obstetrics and OUD management, and a systematic approach to identifying OUD in those who are pregnant and effectively engaging them in OAT is lacking. This paper examined the demographics, costs of treatment, and early outcomes for pregnant mothers and their newborns with prenatal exposure to opioids (PEO).

Methods: A retrospective record review was conducted of all infants born between May 1, 2016 and April 30, 2017 at a large, urban medical center. Infants with PEO were matched with a control group by parent's type of insurance, race/ethnicity, method of birth, and maternal parity.

Results: Of the 3,841 infants birthed during the study period, 131 (3.4%) were born to people with OUD. Significantly more people with OUD than the control group were White and on Medicaid. Those with POUD presented later for and engaged less in prenatal care and only 25 (19.2%) received OAT. They were more likely to deliver prematurely and, if on OAT, by Caesarean Section. Compared to the control group, newborns with PEO were much more likely to be premature, of low birth weight, diagnosed with jaundice and tachypnea, and be admitted to the NICU (71.4% v. 25.4%). Further, they had considerably longer lengths of stay in both the NICU (mean of 14.4 v. 4.1 days) and hospital (16.9 v. 5.8 days). Length of stay also correlated directly with the number of illicit drugs on urine drug screen. A lack of standardization was evident in screening, testing and documenting POUDS, as well as identifying and treating Neonatal Abstinence Syndrome (NAS).

Conclusions: These data underscore the need for a comprehensive, standardized, multi-disciplinary, approach to POUD and affirm the government as a major stakeholder in the care of infants born to these mothers.

References:
Bedrick BS, O'Donnell C, Marx CM, et al. Barriers to accessing opioid agonist therapy in pregnancy. Am J Obstet Gynecol MFM. 2020;2(4):100225.
Clemans-Cope L, Lynch V, Howell E, et al. Pregnant women with opioid use disorder and their infants in three state Medicaid programs in 2013-2016. Drug Alcohol Depend. 2019;195:156-163. doi:10.1016/j.drugalcdep.2018.12.005
Jacobson, M, Wilson, J, et al. The High Cost of Opioid Use in Pregnancy. Ohio Journal of Public Health, submitted for publication, 2021.
Weisberg, Andrew J., co-author. "A Liberal Dilemma: Respecting Autonomy While Also Protecting Inchoate Children from Prenatal Substance Abuse." F. E. Vandervort, co-author. Wm. & Mary Bill of Rts. 24, no. 3 (2016): 659-708.
Wexelblatt, S. L. et al. (2015). Universal maternal drug testing in a high-prevalence region of prescription opiate abuse. The Journal of pediatrics, 166(3), 582–586. https://doi.org/10.1016/j.jpeds.2014.10.004

Diversity, Equity, and Inclusion: The patient population in our Prenatal OUD study were largely economically disadvantaged, disconnected from the healthcare system, and feared stigmatization and loss of their newborn children. This presentation will go beyond a call to reduce stigma to addressing healthcare disparities by calling upon the healthcare community and systems to come together to effectively reverse this disease.