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Investigators from multiple institutions in Canada conducted a retrospective study to evaluate perinatal outcomes in infants born to mothers with opioid use disorder (OUD). For the study, they linked multiple databases to identify mothers with OUD diagnosed before delivery or in the puerperium period with completed pregnancies between April 1, 2000 and March 31, 2019 in British Columbia, Canada. Data abstracted on mothers included age, parity, gestational age, receipt of opioid agonist treatment, timing of treatment (before pregnancy, during pregnancy but not until delivery, or until delivery), type of opioid agonist treatment (methadone, slow release oral morphine [SROM], buprenorphine/naloxone), use of other psychotropic drugs during pregnancy (selective serotonin reuptake inhibitors [SSRIs], benzodiazepines, antipsychotics, and stimulants), tobacco use, and alcohol use. Newborn outcomes included low birth weight (<2,500 g), prematurity (<37 weeks), and neonatal abstinence syndrome (NAS) diagnosis (based on ICD-9 and ICD-10 codes). Descriptive statistics were used to evaluate these outcomes and assess trends over the study period. Linear mixed effects models were used to compare outcomes in babies whose mothers used opioid agonist treatment until delivery and in those who discontinued treatment in pregnancy, and in mothers treated with buprenorphine/naloxone or SROM vs methadone. Models were adjusted for maternal age, parity, use of psychotropic drugs, and alcohol and tobacco use.
A total of 4,574 women were diagnosed with OUD, with 6,693 deliveries and 6,720 live births during the study period. Opioid agonist treatment during pregnancy was documented for 2,824 deliveries (42%), and prescriptions for psychotropic drugs were identified during pregnancy in 2,684 (37%) deliveries. During the study period, the number of cases of OUD in pregnancy increased from 166 in 2000–2001 to 513 in 2018–2019. Rates of use of opioid agonist treatment remained stable during the treatment period; 94.7% of opioid agonist treatment was with methadone. Among the infants born to mothers with OUD, 16% were low birth weight, 24% were born premature, and 2,496 (36.8%) were diagnosed with NAS. In the multivariate models, continued opioid agonist treatment through delivery, compared to treatment discontinuation during pregnancy, was associated with an increased risk of NAS in the infant (odds ratio [OR], 4.7; 95% CI, 3.6, 6.1), but decreased risk of preterm birth (OR, 0.6; 95% CI, 0.4, 0.8) and low birth weight (OR, 0.4; 95% CI, 0.2, 0.7). Compared to methadone, treatment with buprenorphine/naloxone or SROM was associated with lower risks of preterm delivery (OR, 0.6; 95% CI, 0.3, 0.9), low birth weight (OR, 0.6; 95% CI, 0.4, 0.9) and NAS (OR, 0.6; 95% CI, 0.4, 0.9).
The authors conclude the incidence of perinatal OUD in British Columbia more than tripled over a 20-year period.
Dr Von Kohorn has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The documented increases in...
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