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Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure

Marian P Jarlenski1, Elizabeth E Krans2, Joo Yeon Kim3

  • 1Marian P. Jarlenski ( marian. jarlenski@pitt. edu ) is an assistant professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, in Pennsylvania.

Health Affairs (Project Hope)
|February 4, 2020
PubMed

Insights

Children exposed to opioids in utero had fewer well-child visits. However, opioid exposure did not increase the risk of complex chronic conditions in early childhood for these children.

Area of Science:

  • Pediatric Health Outcomes
  • Maternal and Child Health
  • Opioid Use Disorder Research

Background:

  • State Medicaid programs prioritize the health of children affected by maternal opioid use disorder.
  • Limited data exists on the long-term health trajectories of children exposed to opioids in utero enrolled in Medicaid.
  • Understanding developmental and health outcomes is crucial for targeted interventions and support.

Purpose of the Study:

  • To investigate well-child visit utilization among children with in utero opioid exposure.
  • To examine the incidence of pediatric complex chronic conditions in early childhood for opioid-exposed infants.
  • To compare outcomes between children with in utero opioid exposure, tobacco exposure, and neither exposure.

Main Methods:

  • Retrospective cohort study of 82,329 maternal-child dyads from the Pennsylvania Medicaid program.
  • Children born between 2008-2011 were followed for the first five years of life.
  • Analysis included well-child visit adherence and diagnoses of pediatric complex chronic conditions, comparing opioid, tobacco, and unexposed groups.

Main Results:

  • Children with in utero opioid exposure showed a significantly lower probability of recommended well-child visits at 15 months (42.1%) compared to tobacco-exposed (54.1%) and unexposed groups (55.7%).
  • The probability of a pediatric complex chronic condition diagnosis was similar across all groups: opioid-exposed (20.4%), tobacco-exposed (18.7%), and unexposed (20.2%).
  • Findings remained consistent when analyzing a subgroup of opioid-exposed children with neonatal opioid withdrawal symptoms.

Conclusions:

  • In utero opioid exposure is associated with reduced adherence to recommended well-child visits in early childhood.
  • Despite lower visit rates, in utero opioid exposure did not elevate the risk for developing complex chronic conditions within the first five years of life.
  • These findings highlight the need for improved healthcare access and engagement for children with prenatal opioid exposure, while also suggesting resilience regarding complex condition development.

Keywords:
AbstinenceAccess and useChildren's healthChronic diseaseEmergency departmentsHealth conditionsHealth policyMedicaidOpioid use disorderPediatric chronic conditionsPregnancyWell-child visits

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