Infants who were exposed to opioids in utero but not diagnosed with neonatal opioid withdrawal syndrome shortly after birth appear to be at an increased risk of death compared with those who have been diagnosed with neonatal opioid withdrawal syndrome, suggests a study published Monday in JAMA Pediatrics.
“The findings of this study suggest that programs and policies to support women with opioid use disorder and their infants are warranted, regardless of perceived severity of neonatal opioid withdrawal,” wrote JoAnna K. Leyenaar, M.D., Ph.D., M.P.H., of Children’s Hospital at Dartmouth-Hitchcock Medical Center and colleagues.
Leyenaar and colleagues conducted a retrospective cohort study of mother-infant pairs using the Texas Neonatal Intensive Care Project dataset, which includes information on maternal health care claims/encounters during pregnancy and infant mortality. For mother-infant pairs to be included in the study, infants had to be born in Texas between 2010 and 2014 at a gestational age of 22 to 43 weeks to women aged 15 to 44 and insured by Texas Medicaid.
Among the 1,129,032 maternal-infant pairs included in the analysis, 7,207 had prenatal opioid exposure, including 4,238 infants who were diagnosed with neonatal opioid withdrawal syndrome and 2,969 who were not. The infant mortality rate was highest in opioid-exposed infants without neonatal opioid withdrawal syndrome (20 per 1,000 live births), compared with infants with a history of neonatal opioid withdrawal syndrome (11 per 1,000 live births) and infants with no prenatal opioid exposure (6 per 1,000 live births), the authors reported.
After adjusting for maternal and infant characteristics, Leyenaar and colleagues found that infants diagnosed with neonatal opioid withdrawal syndrome were no more likely to die during their first year of life than those with no history of prenatal opioid exposure. In contrast, the odds of death in opioid-exposed infants not diagnosed with neonatal opioid withdrawal syndrome was 72% greater than those infants with no history of opioid exposure.
“The postnatal period is one of substantial risk to women with OUD [opioid use disorder], including increased risks of treatment discontinuation, overdose, and postpartum depression,” Leyenaar and colleagues wrote.
“The findings of our study suggest that opioid-exposed infants are at increased risk of mortality during infancy, and the constellation of treatments and supports provided to infants diagnosed with [neonatal opioid withdrawal syndrome] may be protective. Clinical interventions, public health programs, and health policy to support women with OUD and their infants appear to be warranted, regardless of the perceived severity of neonatal opioid withdrawal,” they concluded.
For related information, see the American Journal of Psychiatry article “Leveraging Telehealth in the United States to Increase Access to Opioid Use Disorder Treatment in Pregnancy and Postpartum During the COVID-19 Pandemic.”
Members Invited to Apply for New Presidential Task Force on Social Determinants of MH
APA members are invited to apply for appointment to the new Task Force on the Social Determinants of Mental Health, which reflects the theme of incoming APA President Vivian Pender, M.D. There will also be eight work groups that will address major issues related to social determinants of mental health. The appointments begin on May 3 and conclude at the close of the 2022 Annual Meeting. Those interested should submit a CV, brief summary of expertise, and specific area of interest to TFSDOMH@psych.org by the deadline of by April 26.
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