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Neonatal Outcomes after Medications for Opioid Use Disorder during Pregnancy in a State Women's Prison Facility,

Andrea K Knittel1, Rita A Swartzwelder, Samantha Zarnick

  • 1From the Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (AKK, JT); University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (RAS, SZ, TH); Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC (TMT, FCL); WakeMed Maternal-Fetal Medicine, Raleigh, NC (JE); North Carolina Department of Public Safety, Raleigh, NC (EA, JA); and UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (HEJ).

Journal of Addiction Medicine
|October 3, 2023
PubMed

Insights

Infants exposed to opioids during maternal incarceration experienced similar neonatal outcomes but longer hospital stays compared to those not incarcerated. Avoiding parent-infant separation may improve outcomes for these vulnerable newborns.

Area of Science:

  • Perinatal health
  • Neonatal outcomes
  • Substance use disorders

Background:

  • Medications for opioid use disorder improve maternal and neonatal health.
  • Limited data exists on infants exposed to opioids during maternal incarceration.

Purpose of the Study:

  • To examine birth outcomes for infants exposed to opioids during perinatal incarceration.
  • To compare outcomes by opioid exposure type.

Main Methods:

  • Retrospective study of infants born to incarcerated individuals with opioid use disorder (2016-2019).
  • Data abstracted from hospital records including length of stay, neonatal opioid withdrawal syndrome (NOWS) severity, and discharge plan.
  • Statistical analyses included descriptive statistics, ANOVA F tests, and chi-square tests.

Main Results:

  • 125 infants analyzed: 34 exposed to methadone, 15 to buprenorphine, 22 to oxycodone, 54 to no opioid medication.
  • High rates of feeding, sleeping, or consoling difficulties observed in methadone (97%) and buprenorphine (80%) exposed infants.
  • 59% of methadone-exposed and 47% of buprenorphine-exposed infants required medication for NOWS.
  • Average hospital length of stay varied significantly by exposure: 4 days (no opioid), 15 days (methadone), 12 days (buprenorphine), and 9 days (oxycodone) (P < 0.001).

Conclusions:

  • Neonatal hospitalization experiences for infants with perinatal opioid exposure during maternal incarceration are similar to those born outside incarceration, with notable differences in hospital length of stay.
  • The majority of opioid-exposed infants required intervention for NOWS symptoms after maternal discharge to prison.
  • Consideration of avoiding parent-infant separation is suggested to improve outcomes.
Abstract

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