TY - JOUR
T1 - The Influence of Mediators on the Relationship Between Antenatal Opioid Agonist Exposure and the Severity of Neonatal Opioid Withdrawal Syndrome
AU - for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and the NIH Environmental influences on Child Health Outcomes (ECHO) Program Institutional Development Awards States Pediatric Clinical Trial
AU - Devlin, Lori A.
AU - Hu, Zhuopei
AU - Ounpraseuth, Songthip
AU - Simon, Alan E.
AU - Annett, Robert D.
AU - Das, Abhik
AU - Fuller, Janell F.
AU - Higgins, Rosemary D.
AU - Merhar, Stephanie L.
AU - Smith, P. Brian
AU - Crawford, Margaret M.
AU - Cottrell, Lesley E.
AU - Czynski, Adam J.
AU - Newman, Sarah
AU - Paul, David A.
AU - Sánchez, Pablo J.
AU - Semmens, Erin O.
AU - Smith, M. Cody
AU - Whalen, Bonny L.
AU - Snowden, Jessica N.
AU - Young, Leslie W.
N1 - © 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2023/6
Y1 - 2023/6
N2 - Objectives: (1) To evaluate the direct (un-mediated) and indirect (mediated) relationship between antenatal exposure to opioid agonist medication as treatment for opioid use disorder (MOUD) and the severity of neonatal opioid withdrawal syndrome (NOWS), and (2) to understand the degree to which mediating factors influence the direct relationship between MOUD exposure and NOWS severity. Methods: This cross-sectional study includes data abstracted from the medical records of 1294 opioid-exposed infants (859 MOUD exposed and 435 non-MOUD exposed) born at or admitted to one of 30 US hospitals from July 1, 2016, to June 30, 2017. Regression models and mediation analyses were used to evaluate the relationship between MOUD exposure and NOWS severity (i.e., infant pharmacologic treatment and length of newborn hospital stay (LOS)) to identify potential mediators of this relationship in analyses adjusted for confounding factors. Results: A direct (un-mediated) association was found between antenatal exposure to MOUD and both pharmacologic treatment for NOWS (aOR 2.34; 95%CI 1.74, 3.14) and an increase in LOS (1.73 days; 95%CI 0.49, 2.98). Delivery of adequate prenatal care and a reduction in polysubstance exposure were mediators of the relationship between MOUD and NOWS severity and as thus, were indirectly associated with a decrease in both pharmacologic treatment for NOWS and LOS. Conclusions for Practice: MOUD exposure is directly associated with NOWS severity. Prenatal care and polysubstance exposure are potential mediators in this relationship. These mediating factors may be targeted to reduce the severity of NOWS while maintaining the important benefits of MOUD during pregnancy.
AB - Objectives: (1) To evaluate the direct (un-mediated) and indirect (mediated) relationship between antenatal exposure to opioid agonist medication as treatment for opioid use disorder (MOUD) and the severity of neonatal opioid withdrawal syndrome (NOWS), and (2) to understand the degree to which mediating factors influence the direct relationship between MOUD exposure and NOWS severity. Methods: This cross-sectional study includes data abstracted from the medical records of 1294 opioid-exposed infants (859 MOUD exposed and 435 non-MOUD exposed) born at or admitted to one of 30 US hospitals from July 1, 2016, to June 30, 2017. Regression models and mediation analyses were used to evaluate the relationship between MOUD exposure and NOWS severity (i.e., infant pharmacologic treatment and length of newborn hospital stay (LOS)) to identify potential mediators of this relationship in analyses adjusted for confounding factors. Results: A direct (un-mediated) association was found between antenatal exposure to MOUD and both pharmacologic treatment for NOWS (aOR 2.34; 95%CI 1.74, 3.14) and an increase in LOS (1.73 days; 95%CI 0.49, 2.98). Delivery of adequate prenatal care and a reduction in polysubstance exposure were mediators of the relationship between MOUD and NOWS severity and as thus, were indirectly associated with a decrease in both pharmacologic treatment for NOWS and LOS. Conclusions for Practice: MOUD exposure is directly associated with NOWS severity. Prenatal care and polysubstance exposure are potential mediators in this relationship. These mediating factors may be targeted to reduce the severity of NOWS while maintaining the important benefits of MOUD during pregnancy.
KW - Length of stay (LOS)
KW - Medication for opioid withdrawal syndrome (MOUD)
KW - Neonatal opioid withdrawal syndrome (NOWS)
KW - Pharmacologic treatment
KW - Polysubstance exposure
KW - Prenatal care
KW - Parturition
KW - Cross-Sectional Studies
KW - Humans
KW - Analgesics, Opioid/adverse effects
KW - Infant
KW - Opioid-Related Disorders/complications
KW - Neonatal Abstinence Syndrome/drug therapy
KW - Pregnancy
KW - Female
KW - Infant, Newborn
UR - http://www.scopus.com/inward/record.url?scp=85149727402&partnerID=8YFLogxK
U2 - 10.1007/s10995-022-03521-3
DO - 10.1007/s10995-022-03521-3
M3 - Article
C2 - 36905529
AN - SCOPUS:85149727402
SN - 1092-7875
VL - 27
SP - 1030
EP - 1042
JO - Maternal and Child Health Journal
JF - Maternal and Child Health Journal
IS - 6
ER -