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Outcomes Associated With Illicit Fentanyl Exposure During Pregnancy: A Retrospective Cohort Study
Kelsey Sullivan1, Lois Bangiolo1, Esther Kisseih1
1Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Hospital Pediatrics
|July 16, 2026
Summary
Illicitly manufactured fentanyl (IMF) exposure during pregnancy is linked to worse infant outcomes. Infants exposed to IMF faced higher risks of preterm birth, low birth weight, and neonatal intensive care unit admission compared to those exposed to medications for opioid use disorder (MOUDs).
Area of Science:
- Perinatal Health
- Neonatal Outcomes
- Substance Use Disorders
Background:
- Illicitly manufactured fentanyl (IMF) is the leading opioid in the US, significantly contributing to pregnancy-related morbidity and mortality.
- Prenatal opioid exposure is a known risk factor for neonatal opioid withdrawal syndrome (NOWS), but IMF's specific impact remains unclear.
- Understanding differential effects of IMF versus other opioids is crucial for maternal and infant health.
Purpose of the Study:
- To evaluate the association between prenatal exposure to illicitly manufactured fentanyl (IMF) and fetal, perinatal, and neonatal health outcomes.
- To compare outcomes in infants exposed prenatally to IMF versus medications for opioid use disorder (MOUDs).
Main Methods:
- Retrospective cohort study of pregnant women with opioid use disorder (OUD) and their infants born between January 2024 and December 2024.
- Participants stratified into IMF-exposed and MOUD-exposed groups based on urine drug testing at delivery.
- Descriptive statistics, chi-squared tests, and t-tests used to compare outcomes between groups.
Main Results:
- Infants exposed to IMF (n=34) showed higher rates of fetal growth restriction, preterm birth, and abnormal growth parameters (low/very low birth weight) compared to MOUD-exposed infants (n=91).
- IMF-exposed infants were significantly more likely to require neonatal intensive care unit (NICU) admission and have longer hospital stays.
- Pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) was more frequent in the IMF-exposed group.
Conclusions:
- Prenatal exposure to illicitly manufactured fentanyl (IMF) is associated with increased neonatal morbidity compared to exposure to medications for opioid use disorder (MOUDs).
- This highlights the critical importance of maternal substance use treatment during pregnancy for improving both maternal and neonatal health.
- Further research and clinical attention are needed to address the risks associated with IMF in pregnancy.
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