Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1030-1042 |
| Number of pages | 13 |
| Journal | Maternal and Child Health Journal |
| Volume | 27 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2023 |
Funding
This manuscript is the product of work from the NICHD Neonatal Research Network and the ECHO IDeA States Pediatric Clinical Trials Network. Both networks are cooperative agreements with the NIH. Only NIH staff listed as authors have contributed to this manuscript. This research was supported through the NIH HEAL Initiative under award numbers: U10 HD36790, U10 HD53089, U10 HD27904, U24OD024957, U2COD023375, UG1 HD21364, UG1 HD27853, UG1 HD68278, UG1OD024942, UG1OD024943, UG1OD024944, UG1OD024945, UG1OD024946, UG1OD024947, UG1OD024948, UG1OD024949, UG1OD024950, UG1OD024951, UG1OD024952, UG1OD024953, UG1OD024954, UG1OD024955, UG1OD024956, UG1OD024958, UG1OD024959, UL1 TR41. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The NIH, the NICHD, and the National Center for Advancing Translational Sciences (NCATS) provided support for the NRN. The NIH, Office of the Director, ECHO program provided support for the ISPCTN. We are indebted to our medical and nursing colleagues from the ISPCTN and NRN who participated in this study detailed in Online Resource 8.
| Funder number |
|---|
| U24OD024957, UG1 HD27853, U10 HD36790, UG1OD024949, UG1OD024956, UG1OD024959, UG1OD024958, UG1OD024953, UG1OD024952, UG1OD024955, UG1OD024954, UG1OD024951, UG1OD024950, U10 HD27904, U2COD023375, U10 HD53089, UG1OD024946, UG1OD024945, UG1OD024948, UG1OD024947, UG1OD024942, UG1OD024944, UG1OD024943, UG1 HD21364, UG1 HD68278 |
Keywords
- Length of stay (LOS)
- Medication for opioid withdrawal syndrome (MOUD)
- Neonatal opioid withdrawal syndrome (NOWS)
- Pharmacologic treatment
- Polysubstance exposure
- Prenatal care
- Parturition
- Cross-Sectional Studies
- Humans
- Analgesics, Opioid/adverse effects
- Infant
- Opioid-Related Disorders/complications
- Neonatal Abstinence Syndrome/drug therapy
- Pregnancy
- Female
- Infant, Newborn
