TY - JOUR
T1 - Outcomes associated with the use of medications for opioid use disorder during pregnancy
AU - Krans, Elizabeth E.
AU - Kim, Joo Yeon
AU - Chen, Qingwen
AU - Rothenberger, Scott D.
AU - James, Alton Everette
AU - Kelley, David
AU - Jarlenski, Marian P.
N1 - Funding Information:
Research reported in this publication was supported by the National Institute on Drug Abuse under Award number R01DA045675 (E.E.K. and M.P.J.). This research was supported by an inter‐governmental agreement between the University of Pittsburgh and the Pennsylvania Department of Human Services. We also greatly acknowledge support for this analysis from Jenny Lo‐Ciganic PhD, MS, MSPharm.
Publisher Copyright:
© 2021 Society for the Study of Addiction
PY - 2021/12
Y1 - 2021/12
N2 - Aim: To test the effect of the duration of medication for opioid use disorder (MOUD) use during pregnancy on maternal, perinatal and neonatal outcomes. Design: Retrospective cohort analysis of claims, encounter and pharmacy data. Setting: Pennsylvania, USA. Participants: We analyzed 13 320 pregnancies among 10 741 women with opioid use disorder aged 15–44 years enrolled in Pennsylvania Medicaid between 2009 and 2017. Measurements: We examined five outcomes during pregnancy and for 12 weeks postpartum: (1) overdose, (2) postpartum MOUD continuation, (3) preterm birth (< 37 weeks gestation), (4) term low birth weight (< 2500 g at ≥ 37 weeks) and (5) neonatal abstinence syndrome (NAS). Our primary exposure was the duration (count of weeks) of any MOUD use, including methadone or buprenorphine, during pregnancy. Findings: Among 13 320 pregnancies, 306 (2.3%) were complicated by an overdose, 1753 (13.2%) resulted in a preterm birth and 6787 (50.9%) continued MOUD postpartum. Among infants, 874 (7.6%) were low birth weight at term and 7706 (57.9%) were diagnosed with NAS. As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS and a decline in term low birth weight. Specifically, for each additional week of MOUD, the adjusted odds of overdose decreased by 2% [adjusted odds ratio (aOR) = 0.98; 95% confidence interval (CI) = 0.97, 0.99], preterm birth decreased by 1% (aOR = 0.99; 95% CI = 0.99, 1.00), postpartum MOUD continuation increased by 95% (aOR = 1.95; 95% CI = 1.87, 2.04) and NAS increased by 41% (aOR = 1.41; 95% CI = 1.35, 1.47). The odds of term low birth weight did not change (aOR = 1.00; 95% CI = 0.99, 1.00), although the rate declined with a longer duration of MOUD use during pregnancy. Conclusions: Longer duration of medication for opioid use disorder use during pregnancy appears to be associated with improved maternal and perinatal outcomes.
AB - Aim: To test the effect of the duration of medication for opioid use disorder (MOUD) use during pregnancy on maternal, perinatal and neonatal outcomes. Design: Retrospective cohort analysis of claims, encounter and pharmacy data. Setting: Pennsylvania, USA. Participants: We analyzed 13 320 pregnancies among 10 741 women with opioid use disorder aged 15–44 years enrolled in Pennsylvania Medicaid between 2009 and 2017. Measurements: We examined five outcomes during pregnancy and for 12 weeks postpartum: (1) overdose, (2) postpartum MOUD continuation, (3) preterm birth (< 37 weeks gestation), (4) term low birth weight (< 2500 g at ≥ 37 weeks) and (5) neonatal abstinence syndrome (NAS). Our primary exposure was the duration (count of weeks) of any MOUD use, including methadone or buprenorphine, during pregnancy. Findings: Among 13 320 pregnancies, 306 (2.3%) were complicated by an overdose, 1753 (13.2%) resulted in a preterm birth and 6787 (50.9%) continued MOUD postpartum. Among infants, 874 (7.6%) were low birth weight at term and 7706 (57.9%) were diagnosed with NAS. As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS and a decline in term low birth weight. Specifically, for each additional week of MOUD, the adjusted odds of overdose decreased by 2% [adjusted odds ratio (aOR) = 0.98; 95% confidence interval (CI) = 0.97, 0.99], preterm birth decreased by 1% (aOR = 0.99; 95% CI = 0.99, 1.00), postpartum MOUD continuation increased by 95% (aOR = 1.95; 95% CI = 1.87, 2.04) and NAS increased by 41% (aOR = 1.41; 95% CI = 1.35, 1.47). The odds of term low birth weight did not change (aOR = 1.00; 95% CI = 0.99, 1.00), although the rate declined with a longer duration of MOUD use during pregnancy. Conclusions: Longer duration of medication for opioid use disorder use during pregnancy appears to be associated with improved maternal and perinatal outcomes.
KW - Low birthweight
KW - NAS
KW - medication for opioid use disorder
KW - neonatal abstinence syndrome
KW - opioid use disorder
KW - overdose
KW - postpartum
KW - pregnancy
KW - preterm birth
KW - substance use disorder
UR - http://www.scopus.com/inward/record.url?scp=85107573650&partnerID=8YFLogxK
U2 - 10.1111/add.15582
DO - 10.1111/add.15582
M3 - Article
AN - SCOPUS:85107573650
SN - 0965-2140
VL - 116
SP - 3504
EP - 3514
JO - Addiction
JF - Addiction
IS - 12
ER -