Moms With OUD: Improved Infant Care Seen With Use of Prenatal Addiction Meds

For mothers with opioid use disorder (OUD), the use of medication for their addiction such as buprenorphine or methadone during the prenatal period was associated with improved outcomes in infants, a cross-sectional study showed.

Using data from a multistate Medicaid database on over 10,000 mother-infant dyads, prenatal use of medications for OUD was found to be associated with 20% higher odds of infants receiving six well-child visits (adjusted OR 1.20, 95% CI 1.11-1.31) and 20% lower odds of readmissions (aOR 0.80, 95% CI 0.70-0.91) during the first year of life, reported Mir M. Ali, PhD, of the Office of the Assistant Secretary for Planning and Evaluation at HHS, and co-authors.

Prenatal medications for OUD use was inversely associated with any emergency department (ED) visits, but this result was not significant, they added.

These findings were "consistent with the hypothesis that when pregnant individuals are engaged in OUD treatment, their infants are also likely to receive the appropriate levels of care," the authors wrote in a research letter published in JAMA Pediatrics.

"Additionally, we found that prenatal MOUD [medication for OUD] use was associated with lower odds of hospital readmissions after birth, a costly and potentially avoidable health service use that is common among infants with neonatal abstinence syndrome and signifies exacerbation of symptoms," they added, noting that "treatment during the prenatal period may have long-term implications for infant health by ameliorating the harm caused by untreated OUD."

Co-author Stephen W. Patrick, MD, MPH, MSc, of the Vanderbilt Center for Child Health Policy and Vanderbilt University Medical Center in Nashville, Tennessee, told MedPage Today that this new research fills a gap in the existing literature.

"We know that when pregnant people with opioid use disorder are treated with medications for opioid use disorder they are more likely to carry the pregnancy to term and their infants are less likely to be born low birth weight. However, we know little about the effect of maternal treatment on long-term outcomes," Patrick said.

"As a practicing neonatologist, I care for opioid-exposed infants regularly and our research team conducts research which aims to understand how we can improve outcomes for both mothers and infants affected by the opioid crisis," he continued. "We have known for years that medications for opioid use disorder, like buprenorphine and methadone, decrease risk of overdose death and improve pregnancy outcomes. This study finds an important spillover effect with improvement in outcomes during the first year of life for infants of mothers treated with medications for opioid use disorder."

Patrick also highlighted that access to medications for OUD for pregnant women is a "public health and policy imperative."

"There are far too many barriers to treatment for pregnant women, which may be why we are seeing record levels of overdose deaths among pregnant women," he added. "There is an urgent need to expand access to improve outcomes for mothers and infants."

Patrick said that he and his team are hoping to do future research that will help "better understand how interventions during pregnancy among individuals with opioid use disorder may improve outcomes beyond the neonatal period."

For this study, Ali and colleagues analyzed data from 2012 to 2019 from the Merative MarketScan multistate Medicaid database, which captures data on 6 to 10 states per year. They included 10,352 mother-infant dyads (51.8% boys). More than half of mothers (55.3%) didn't receive MOUD at all.

The mothers in the cohort had OUD and 9 months of continuous enrollment before giving birth, with 1 year of continuous enrollment after birth. About 40% were ages 25-29 at birth, and 25.6% were 30-34. Most of the women were white (83.3%), and 9.2% were Black.

Ali and colleagues noted a few limitations to their study, including its observational nature, which cannot account for unobserved confounders, such as the mothers' access to transportation, social supports, or general home life stability. Additionally, since the analyzed Medicaid-covered mother-infant dyads were from only a few states, the same results might not apply to a national sample.

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