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Delivery timing for the opioid–exposed infant

  • Ayodeji Sanusi
    Correspondence
    Corresponding author: Ayodeji Sanusi, MD MPH.
    Affiliations
    Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)

    Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
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  • Meredith Gray
    Affiliations
    Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)

    Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
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  • Yumo Xue
    Affiliations
    Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL (Mr Xue and Dr Szychowski)
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  • Sydney Mohr
    Affiliations
    Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK (Dr Mohr)
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  • Peyton Curtis
    Affiliations
    School of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Mres Curtis and Dismukes)
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  • Jonathan Dismukes
    Affiliations
    School of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Mres Curtis and Dismukes)
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  • Samuel Gentle
    Affiliations
    Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL (Dr Gentle)
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  • Jeff M. Szychowski
    Affiliations
    Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)

    Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)

    Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL (Mr Xue and Dr Szychowski)
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  • Brian Brocato
    Affiliations
    Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)

    Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
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  • Brian Casey
    Affiliations
    Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)

    Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
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  • Lorie Harper
    Affiliations
    Department of Women's Health, The University of Texas at Austin, Dell Medical School, Austin, TX (Dr Harper)
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  • Rachel Sinkey
    Affiliations
    Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)

    Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
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      BACKGROUND

      The prevalence of opioid use disorder and medication-assisted treatment in pregnancy is increasing. Compared with term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome. It is unknown whether early term delivery compared with full or late-term delivery decreases the risk of neonatal opioid withdrawal syndrome.

      OBJECTIVE

      This study aimed to compare the neonatal outcomes among opioid–exposed infants born in the early, full, and late-term periods.

      STUDY DESIGN

      This was a retrospective cohort study of opioid–exposed pregnancies delivering at a single center from 2010 to 2017 at ≥37 weeks gestation. Participants with multiple gestations or fetal anomalies were excluded. Maternal opioid exposure was defined as prescription (including medication-assisted treatment) or nonprescription opioid use or a positive urine drug screen in pregnancy for opiates. The primary outcome was a neonatal composite of respiratory distress syndrome, neonatal sepsis, neonatal seizures, hypoxic ischemic encephalopathy, jaundice requiring treatment, 5-minute Apgar <5, neonatal intensive care unit admission, neonatal opioid withdrawal syndrome, or neonatal death. The secondary outcomes included individual components of the primary outcome, birthweight, need for and length of neonatal opioid withdrawal syndrome treatment, length of hospital admission, and maximum Finnegan scores. Early (37–<39), full (39–<41), and late (41–<42 weeks) term groups were defined by the American College of Obstetricians and Gynecologists.

      RESULTS

      Of 399 infants, 136 (34.1%), 229 (57.4%), and 34 (8.5%) were born in the early, full, and late-term periods, respectively. Two hundred and seventy patients (67.7%) received medication-assisted treatment for opioid use disorder, and the baseline characteristics were similar in all the groups except for history of intranasal heroin use, positive urine toxicology screen for heroin or any opiates, and delivery indication (P<.05). The primary composite outcome occurred in 313 (78.4%) neonates, and 296 (74.2%) neonates had neonatal opioid withdrawal syndrome. More than half (219 [54.9%]) of opioid–exposed neonates were admitted to the neonatal intensive care unit, and 160 (40.1%) required pharmacologic neonatal opioid withdrawal syndrome treatment for a mean duration of almost 3 weeks (19.0±16.1 days). There were no significant differences in the primary composite outcome, incidence of neonatal opioid withdrawal syndrome, or other secondary outcomes (except birthweight) between neonates born in the early, full, or late-term periods.

      CONCLUSION

      Although neonatal morbidity was frequent among opioid–exposed neonates, the incidence and severity of neonatal opioid withdrawal syndrome or other neonatal outcomes were not different between neonates delivered in the early, full, and late-term periods, suggesting that opioid–exposed infants may not benefit from early term delivery.

      Keywords

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      References

        • Vesga-López O
        • Blanco C
        • Keyes K
        • Olfson M
        • Grant BF
        • Hasin DS.
        Psychiatric disorders in pregnant and postpartum women in the United States.
        Arch Gen Psychiatry. 2008; 65: 805-815
        • Ko JY
        • D'Angelo DV
        • Haight SC
        • et al.
        Vital signs: prescription opioid pain reliever use during pregnancy - 34 U.S. jurisdictions, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 897-903
        • Sujan A
        • Cleary E
        • Douglas E
        • et al.
        A retrospective, observational study on medication for opioid use disorder during pregnancy and risk for neonatal abstinence syndrome.
        Fam Pract. 2022; 39: 311-315
        • Austin AE
        • Di Bona VD
        • Cox ME
        • Proescholdbell S
        • Fliss MD
        • Naumann RB
        Prenatal use of medication for opioid use disorder and other prescription opioids in cases of Neonatal Opioid Withdrawal Syndrome: North Carolina Medicaid, 2016-2018.
        Am J Public Health. 2021; 111: 1682-1685
        • Smith J
        • Lafferty M
        • Boelig RC
        • et al.
        Is maternal methadone dose associated with the severity of neonatal abstinence syndrome?.
        Am J Perinatol. 2022; 39: 1138-1144
        • Krans EE
        • Kim JY
        • Chen Q
        • et al.
        Outcomes associated with the use of medications for opioid use disorder during pregnancy.
        Addiction. 2021; 116: 3504-3514
        • Link HM
        • Jones H
        • Miller L
        • Kaltenbach K
        • Seligman N.
        Buprenorphine-naloxone use in pregnancy: a systematic review and metaanalysis.
        Am J Obstet Gynecol MFM. 2020; 2100179
        • Patrick SW
        • Schumacher RE
        • Benneyworth BD
        • Krans EE
        • McAllister JM
        • Davis MM.
        Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009.
        JAMA. 2012; 307: 1934-1940
        • Patrick SW
        • Davis MM
        • Lehman CU
        • Cooper WO.
        Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012.
        J Perinatol. 2015; 35: 667
        • Hirai AH
        • Ko JY
        • Owens PL
        • Stocks C
        • Patrick SW.
        Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010-2017.
        JAMA. 2021; 325: 146-155
        • Shrestha S
        • Roberts MH
        • Maxwell JR
        • Leeman LM
        • Bakhireva LN.
        Post-discharge healthcare utilization in infants with neonatal opioid withdrawal syndrome.
        Neurotoxicol Teratol. 2021; 86106975
        • Jilani SM
        • West K
        • Jacobus-Kantor L
        • et al.
        Evaluation of state-led surveillance of neonatal abstinence syndrome - six U.S. States, 2018-2021.
        MMWR Morb Mortal Wkly Rep. 2022; 71: 37-42
        • Honein MA
        • Boyle C
        • Redfield RR.
        Public health surveillance of prenatal opioid exposure in mothers and infants.
        Pediatrics. 2019; 143e20183801
        • Ruwanpathirana R
        • Abdel-Latif ME
        • Burns L
        • et al.
        Prematurity reduces the severity and need for treatment of neonatal abstinence syndrome.
        Acta paediatr. 2015; 104: e188-e194
        • Lemon LS
        • Naimi A
        • Caritis SN
        • Platt RW
        • Venkataramanan R
        • Bodnar LM.
        The role of preterm birth in the association between Opioid Maintenance Therapy and Neonatal Abstinence Syndrome.
        Paediatr Perinat Epidemiol. 2018; 32: 213-222
        • Allocco E
        • Melker M
        • Rojas-Miguez F
        • Bradley C
        • Hahn KA
        • Wachman EM.
        Comparison of neonatal abstinence syndrome manifestations in preterm versus term opioid-exposed infants.
        Adv Neonatal Care. 2016; 16: 329-336
        • Gibson KS
        • Stark S
        • Kumar D
        • Bailit JL.
        The relationship between gestational age and the severity of neonatal abstinence syndrome.
        Addiction. 2017; 112: 711-716
        • Liu AJW
        • Jones MP
        • Murray H
        • Cook CM
        • Nanan R.
        Perinatal risk factors for the neonatal abstinence syndrome in infants born to women on methadone maintenance therapy.
        Aust N Z J Obstet Gynaecol. 2010; 50: 253-258
      1. ACOG Committee Opinion No 579: definition of term pregnancy.
        Obstet Gynecol. 2013; 122: 1139-1140
        • Velez M
        • Jansson LM.
        The Opioid dependent mother and newborn dyad: non-pharmacologic care.
        J Addict Med. 2008; 2: 113-120
        • Straub L
        • Huybrechts KF
        • Hernández-Díaz S
        • et al.
        Trajectories of prescription opioid utilization during pregnancy among prepregnancy chronic users and risk of neonatal opioid withdrawal syndrome.
        Am J Epidemiol. 2022; 191: 208-219
        • Lemon LS
        • Caritis SN
        • Venkataramanan R
        • Platt RW
        • Bodnar LM.
        Methadone versus buprenorphine for opioid use dependence and risk of neonatal abstinence syndrome.
        Epidemiology. 2018; 29: 261-268
        • Kelty E
        • Preen DB.
        Risk factors associated with the occurrence of neonatal opioid withdrawal syndrome: a review.
        CNS Drugs. 2019; 33: 1113-1120
        • Dysart K
        • Hsieh HC
        • Kaltenbach K
        • Greenspan JS.
        Sequela of preterm versus term infants born to mothers on a methadone maintenance program: differential course of neonatal abstinence syndrome.
        J Perinat Med. 2007; 35: 344-346
        • Hieronymus TL
        • Nanovskaya TN
        • Deshmukh SV
        • Vargas R
        • Hankins GDV
        • Ahmed MS.
        Methadone metabolism by early gestational age placentas.
        Am J Perinatol. 2006; 23: 287-294
        • Tita ATN
        • Landon MB
        • Spong CY
        • et al.
        Timing of elective repeat cesarean delivery at term and neonatal outcomes.
        N Engl J Med. 2009; 360: 111-120
        • Brown JA
        • Sinkey RG
        • Steffensen TS
        • Louis-Jacques AF
        • Louis JM.
        Neonatal abstinence syndrome among infants born to mothers with sickle cell hemoglobinopathies.
        Am J Perinatol. 2020; 37: 326-332
      2. Benson PV, Beverly RE, Blair EH, Green RG. Review of 2016 Maternal Mortality. Alabama Maternal Mortality Review.https://www.alabamapublichealth.gov/perinatal/assets/2016MMR_Report_FINAL.pdf. Accessed August 26, 2020.

        • Metz TD
        • Rovner P
        • Hoffman MC
        • Allshouse AA
        • Beckwith KM
        • Binswanger IA.
        Maternal deaths from suicide and overdose in Colorado, 2004-2012.
        Obstet Gynecol. 2016; 128: 1233-1240
        • Schiff DM
        • Grossman MR.
        Beyond the Finnegan scoring system: novel assessment and diagnostic techniques for the opioid-exposed infant.
        Semin Fetal Neonatal Med. 2019; 24: 115-120
        • Grossman MR
        • Lipshaw MJ
        • Osborn RR
        • Berkwitt AK.
        A novel approach to assessing infants with neonatal abstinence syndrome.
        Hosp Pediatr. 2018; 8: 1-6