September 9, 2021

Opioid use during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS), a treatable condition among infants. While NOWS can develop after prenatal exposure to illicit and prescription opioids, it can also develop after prenatal exposure to medications for the treatment of opioid use disorder (MOUD), including methadone and buprenorphine.

A new study from the UNC Gillings School of Global Public Health suggests that among Medicaid patients in North Carolina, about half of infants with NOWS are born to people receiving medication for the treatment of opioid use disorder – and these babies are more likely to experience better outcomes after birth.

Dr. Anna Austin

Dr. Anna Austin

Published in the American Journal of Public Health, the study was led by Anna Austin, PhD, an assistant professor in the Department of Maternal and Child Health and core faculty at the UNC Injury Prevention Research Center (IPRC). Austin worked in collaboration with Becky Naumann, PhD, assistant professor of epidemiology and IPRC core faculty, and Michael Dolan Fliss, PhD, a public health data scientist at IPRC. Vito Di Bona, MS; Mary E. Cox, MPH; and Scott Proescholdbell, MPH, from the N.C. Department of Health and Human Services Division of Public Health also contributed.

“Assumptions are often made that a person who delivers an infant with NOWS was not acting in the infant’s best interests during pregnancy,” Austin explained. “Treatment with methadone or buprenorphine is currently the evidence-based standard of care for an opioid use disorder in pregnancy. We wanted to highlight the role of these treatments in cases of NOWS to try to address some of the stigma associated with this condition.”

Austin’s team used N.C. birth certificate and Medicaid data between 2016 and 2018 to determine how many babies diagnosed with NOWS were born to people who had a claim for MOUD or another prescription opioid in pregnancy.

They found that 60 percent of people who gave birth to infants with NOWS had MOUD or prescription opioid claims in pregnancy. Nearly half had a claim for MOUD, and more than 1 in 5 had a claim for prescription opioids.

Infants born to those who had claims for MOUD or both MOUD and prescription opioids in pregnancy were more likely to be born at full term and at standard birth weight. These findings are consistent with research that suggests MOUD is associated with improved maternal and infant outcomes in comparison to detoxification or continued opioid use.

Among those with claims for MOUD or MOUD and prescription opioids in pregnancy, younger women and non-Hispanic Black women were underrepresented, indicating an urgent need to improve equity in access to MOUD among pregnant populations. Two-thirds of this group also used tobacco in pregnancy, which is often associated with greater severity of NOWS.

Results from this study highlight the extent to which NOWS may be a result of medically appropriate opioid use in pregnancy, particularly the use of methadone or buprenorphine, which are evidence-based treatments for opioid use disorders in pregnancy.

“Our hope is that these results can be used by state and local partners to address some of the stigma associated with having an infant diagnosed with NOWS by highlighting the use of treatment and opioids as prescribed by a health care provider among mothers of infants with NOWS,” said Austin. “Given that NOWS is an expected and treatable condition following prenatal exposure to methadone, buprenorphine and other prescription opioids, we recommend prioritizing interventions that are effective in reducing the severity of NOWS symptoms, such as tobacco cessation programs in pregnancy, and that are effective in treating NOWS, such as the Eat, Sleep, Console method used at UNC Hospitals.”

Austin says her team is currently continuing research in this area, with a focus on examining the association of MOUD in pregnancy with maternal and infant mortality in the first year postpartum.

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