1
|
Ehrenthal DB, Wang Y, Pac J, Durrance CP, Kirby RS, Berger LM. Trends in prenatal prescription opioid use among Medicaid beneficiaries in Wisconsin, 2010-2019. J Perinatol 2024; 44:1111-1118. [PMID: 38561393 DOI: 10.1038/s41372-024-01954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To examine changes in prenatal opioid prescription exposure following new guidelines and policies. STUDY DESIGN Cohort study of all (262,284) Wisconsin Medicaid-insured live births 2010-2019. Prenatal exposures were classified as analgesic, short term, and chronic (90+ days), and medications used to treat opioid use disorder (MOUD). We describe overall and stratified temporal trends and used linear probability models with interaction terms to test their significance. RESULT We found 42,437 (16.2%) infants with prenatal exposure; most (90.5%) reflected analgesic opioids. From 2010 to 2019, overall exposure declined 12.8 percentage points (95% CI = 12.1-13.1). Reductions were observed across maternal demographic groups and in both rural and urban settings, though the extent varied. There was a small reduction in chronic analgesic exposure and a concurrent increase in MOUD. CONCLUSION Broad and sustained declines in prenatal prescription opioid exposure occurred over the decade, with little change in the percentage of infants chronically exposed.
Collapse
Affiliation(s)
- Deborah B Ehrenthal
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA.
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA.
| | - Yi Wang
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
- Silberman School of Social Work, Hunter College, City University of New York, New York, NY, USA
| | - Jessica Pac
- Sandra Rosenbaum School of Social Work, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Christine Piette Durrance
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- La Follette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lawrence M Berger
- Sandra Rosenbaum School of Social Work, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
- Institute for Research on Poverty, College of Letters and Sciences, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
2
|
Sanusi A, Gray M, Xue Y, Mohr S, Curtis P, Dismukes J, Gentle S, Szychowski JM, Brocato B, Casey B, Harper L, Sinkey R. Delivery timing for the opioid-exposed infant. Am J Obstet Gynecol MFM 2022; 4:100719. [PMID: 35977700 PMCID: PMC10961100 DOI: 10.1016/j.ajogmf.2022.100719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence of opioid use disorder and medication-assisted treatment in pregnancy is increasing. Compared with term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome. It is unknown whether early term delivery compared with full or late-term delivery decreases the risk of neonatal opioid withdrawal syndrome. OBJECTIVE This study aimed to compare the neonatal outcomes among opioid-exposed infants born in the early, full, and late-term periods. STUDY DESIGN This was a retrospective cohort study of opioid-exposed pregnancies delivering at a single center from 2010 to 2017 at ≥37 weeks gestation. Participants with multiple gestations or fetal anomalies were excluded. Maternal opioid exposure was defined as prescription (including medication-assisted treatment) or nonprescription opioid use or a positive urine drug screen in pregnancy for opiates. The primary outcome was a neonatal composite of respiratory distress syndrome, neonatal sepsis, neonatal seizures, hypoxic ischemic encephalopathy, jaundice requiring treatment, 5-minute Apgar <5, neonatal intensive care unit admission, neonatal opioid withdrawal syndrome, or neonatal death. The secondary outcomes included individual components of the primary outcome, birthweight, need for and length of neonatal opioid withdrawal syndrome treatment, length of hospital admission, and maximum Finnegan scores. Early (37-<39), full (39-<41), and late (41-<42 weeks) term groups were defined by the American College of Obstetricians and Gynecologists. RESULTS Of 399 infants, 136 (34.1%), 229 (57.4%), and 34 (8.5%) were born in the early, full, and late-term periods, respectively. Two hundred and seventy patients (67.7%) received medication-assisted treatment for opioid use disorder, and the baseline characteristics were similar in all the groups except for history of intranasal heroin use, positive urine toxicology screen for heroin or any opiates, and delivery indication (P<.05). The primary composite outcome occurred in 313 (78.4%) neonates, and 296 (74.2%) neonates had neonatal opioid withdrawal syndrome. More than half (219 [54.9%]) of opioid-exposed neonates were admitted to the neonatal intensive care unit, and 160 (40.1%) required pharmacologic neonatal opioid withdrawal syndrome treatment for a mean duration of almost 3 weeks (19.0±16.1 days). There were no significant differences in the primary composite outcome, incidence of neonatal opioid withdrawal syndrome, or other secondary outcomes (except birthweight) between neonates born in the early, full, or late-term periods. CONCLUSION Although neonatal morbidity was frequent among opioid-exposed neonates, the incidence and severity of neonatal opioid withdrawal syndrome or other neonatal outcomes were not different between neonates delivered in the early, full, and late-term periods, suggesting that opioid-exposed infants may not benefit from early term delivery.
Collapse
Affiliation(s)
- Ayodeji Sanusi
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey).
| | - Meredith Gray
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
| | - Yumo Xue
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL (Mr Xue and Dr Szychowski)
| | - Sydney Mohr
- Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK (Dr Mohr)
| | - Peyton Curtis
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Mres Curtis and Dismukes)
| | - Jonathan Dismukes
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Mres Curtis and Dismukes)
| | - Samuel Gentle
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL (Dr Gentle)
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL (Mr Xue and Dr Szychowski)
| | - Brian Brocato
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
| | - Brian Casey
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
| | - Lorie Harper
- Department of Women's Health, The University of Texas at Austin, Dell Medical School, Austin, TX (Dr Harper)
| | - Rachel Sinkey
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
| |
Collapse
|
3
|
Austin AE, Naumann RB, Simmons E. Association of State Child Abuse Policies and Mandated Reporting Policies With Prenatal and Postpartum Care Among Women Who Engaged in Substance Use During Pregnancy. JAMA Pediatr 2022; 176:1123-1130. [PMID: 36121649 PMCID: PMC9486638 DOI: 10.1001/jamapediatrics.2022.3396] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022]
Abstract
Importance Some states have implemented policies that consider substance use during pregnancy as child abuse and require mandated reporting of substance use during pregnancy. Implications of these policies for health care receipt among pregnant people who engage in substance use are unknown. Objective To examine the association of state child abuse policies and mandated reporting policies with prenatal and postpartum care among women who engaged in substance use during pregnancy. Design, Setting, and Participants In this cross-sectional study, data from the 2016-2019 Pregnancy Risk Assessment Monitoring System survey were analyzed. The study population included 4155 women from 23 states who reported substance use during pregnancy. Data were analyzed between August and November 2021. Exposures Delivery in a state with a child abuse policy only (n = 6), a mandated reporting policy only (n = 4), both policies (n = 7), or neither policy (n = 5). One state switched from a mandated reporting policy only to having both policies. Main Outcomes and Measures Month of gestation at prenatal care initiation (ie, months 1-10, with a higher number of months indicating later initiation), receipt of adequate prenatal care, and receipt of a postpartum health care visit 4 to 6 weeks after delivery. Sample characteristics were calculated using unweighted frequencies and weighted percentages and means. Associations of state policies with the outcomes were examined using generalized linear regression with generalized estimating equations, adjusting for potential confounders and accounting for the complex sampling design of the Pregnancy Risk Assessment Monitoring System survey. Results The study sample included 4155 women who reported substance use during pregnancy; 33.9% of these women delivered in states with a child abuse policy only, 16.4% in states with a mandated reporting policy only, 32.9% in states with both policies, and 16.8% in states with neither policy. Overall, 14.7% of women were Black, 69.0% were White, and 64.6% were aged 18 to 29 years at delivery. Women who delivered in states with a child abuse policy only, mandated reporting policy only, or both policies initiated prenatal care at a later month of gestation (β = 0.44 [95% CI, 0.10-0.78], 0.32 [95% CI, 0.04-0.59], and 0.40 [95% CI, 0.09-0.72], respectively) and had a lower likelihood of adequate prenatal care (risk ratio, 0.85 [95% CI, 0.79-0.91], 0.94 [95% CI, 0.87-1.01], and 0.95 [95% CI, 0.89-1.03], respectively) and a postpartum health care visit (risk ratio, 0.89 [95% CI, 0.82-0.96], 0.89 [95% CI, 0.80-0.98], and 0.92 [95% CI, 0.83-1.02], respectively) compared with women who delivered in states with neither policy. Conclusions and Relevance The results indicate that state child abuse policies and mandated reporting policies are associated with reduced receipt of prenatal and postpartum care among women who engage in substance use during pregnancy.
Collapse
Affiliation(s)
- Anna E. Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Rebecca B. Naumann
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Elizabeth Simmons
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
- Carolina Population Center, University of North Carolina at Chapel Hill
| |
Collapse
|
4
|
Austin AE, Di Bona V, Cox ME, Proescholdbell SK, Naumann RB. Differences in Mortality Among Infants With Neonatal Opioid Withdrawal Syndrome. Am J Prev Med 2022; 63:619-623. [PMID: 35489960 DOI: 10.1016/j.amepre.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Prior studies are mixed regarding whether infants diagnosed with neonatal opioid withdrawal syndrome have a higher risk of mortality than other infants. However, these studies have not accounted for whether mothers of infants with neonatal opioid withdrawal syndrome received medication for opioid use disorder in pregnancy. METHODS Linked data from 2016‒2018 North Carolina birth certificates, maternal and infant Medicaid claims, and infant death certificates were analyzed in summer 2021 to compare mortality and causes of mortality before age 1 year among infants diagnosed with neonatal opioid withdrawal syndrome whose mothers did and did not have claims for medication for opioid use disorder in pregnancy (N=4,480). RESULTS Compared with mothers with medication for opioid use disorder claims in pregnancy (45.5%), mothers without medication for opioid use disorder claims (55.5%) were younger, more likely to be Black non-Hispanic, less likely to have paternity established, and more likely to have no prenatal care. The proportion (1.3%, n=31 vs 1.0%, n=21) and rate (3.5 vs 2.9 deaths per 100,000 infant days) of mortality was higher among infants of mothers without medication for opioid use disorder claims than infants of mothers with medication for opioid use disorder claims. Sudden unexpected infant death syndrome was the primary cause of death for infants of mothers with (90.5%) and without (58.1%) medication for opioid use disorder claims. CONCLUSIONS Results highlight the importance of assessing for potential differences in outcomes according to whether infants with neonatal opioid withdrawal syndrome were exposed to medication for opioid use disorder. Efforts to ensure equitable access to medication for opioid use disorder and other support services in pregnancy are needed to promote healthy maternal and infant outcomes.
Collapse
Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Vito Di Bona
- North Carolina State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Mary E Cox
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Scott K Proescholdbell
- Injury and Violence Prevention Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Rebecca B Naumann
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
5
|
Simmons E, Austin AE. Association of prenatal substance use with prenatal and postpartum care: Evidence from the Pregnancy Risk Assessment Monitoring System, 2016-2019. Prev Med 2022; 159:107065. [PMID: 35461958 PMCID: PMC10018998 DOI: 10.1016/j.ypmed.2022.107065] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/27/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022]
Abstract
The objective of this study was to build on existing qualitative research to estimate the association of prenatal substance use with prenatal and postpartum care. We used data from the 2016-2019 Pregnancy Risk Assessment Monitoring System for 9 states. We conducted adjusted linear regression to compare month of gestation of first prenatal visit and adjusted logistic regression to compare receipt of adequate prenatal care and a postpartum healthcare visit among women who reported prenatal use of any opioids, prescription opioids, marijuana, and illicit drugs to those who did not report use of each substance. Women who reported prenatal use of any opioids (Risk Difference(RD) = 0.16; 95% Confidence Interval (CI) = 0.04, 0.28), prescription opioids (RD = 0.16; 95% CI = 0.04, 0.28), marijuana (RD = 0.25; 95% CI = 0.10, 0.41) and illicit drugs (RD = 0.52; 95% CI = 0.09, 0.95) initiated prenatal care later than those who did not report use of each substance. Women who reported prenatal use of any opioid (Odds Ratio (OR) = 0.82; 95% CI = 0.68, 1.00), prescription opioids (OR = 0.84; 95% CI = 0.69, 1.02), marijuana (OR = 0.59; 95% CI = 0.48, 0.73) and illicit drugs (OR = 0.29; 95% CI = 0.20, 0.42) were less likely to receive adequate prenatal care. Women who reported prenatal use of any opioid (OR = 0.82, 95% CI = 0.65, 1.04), prescription opioids (OR = 0.83; 95% CI = 0.66, 1.05), marijuana (OR = 0.65; 95% CI = 0.51, 0.82) and illicit drugs (OR = 0.47; 95% CI = 0.30, 0.72) had a lower likelihood of a postpartum visit than those who did not report use of each substance. Results indicate potential intervention points for pregnant women who use substances.
Collapse
Affiliation(s)
- Elizabeth Simmons
- The Department of Maternal and Child Health, the Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, USA.
| | - Anna E Austin
- The Department of Maternal and Child Health, the Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, UNC Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|