Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America.
Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America.
Prev Med. 2024 Apr;181:107914. doi: 10.1016/j.ypmed.2024.107914. Epub 2024 Feb 24.
The difference in infant health outcomes by maternal opioid use disorder (OUD) status is understudied. We measured the association between maternal OUD during pregnancy and infant mortality and investigated whether this association differs by infant neonatal opioid withdrawal syndrome (NOWS) or maternal receipt of medication for OUD (MOUD) during pregnancy.
We sampled 204,543 Medicaid-paid births from Wisconsin, United States (2010-2018). The primary exposure was any maternal OUD during pregnancy. We also stratified this exposure on NOWS diagnosis (no OUD; OUD without NOWS; OUD with NOWS) and on maternal MOUD receipt (no OUD; OUD without MOUD; OUD with <90 consecutive days of MOUD; OUD with 90+ consecutive days of MOUD). Our outcome was infant mortality (death at age <365 days). Demographic-adjusted logistic regressions measured associations with odds ratios (OR) and 95% confidence intervals (CI).
Maternal OUD was associated with increased odds of infant mortality (OR 1.43; 95% CI 1.02-2.02). After excluding infants who died <5 days post-birth (i.e., before the clinical presentation of NOWS), regression estimates of infant mortality did not significantly differ by NOWS diagnosis. Likewise, regression estimates did not significantly differ by maternal MOUD receipt in the full sample.
Maternal OUD is associated with an elevated risk of infant mortality without evidence of modification by NOWS nor by maternal MOUD treatment. Future research should investigate potential mechanisms linking maternal OUD, NOWS, MOUD treatment, and infant mortality to better inform clinical intervention.
产妇阿片类药物使用障碍（OUD）状况对婴儿健康结局的影响差异尚未得到充分研究。本研究旨在评估妊娠期间产妇 OUD 与婴儿死亡率之间的关联，并探讨这种关联是否因婴儿新生儿阿片戒断综合征（NOWS）或妊娠期间产妇接受阿片类药物治疗（MOUD）而有所不同。
我们从美国威斯康星州的医疗补助计划（Medicaid）支付的出生记录中抽取了 204543 例（2010-2018 年）。主要暴露因素为妊娠期间任何产妇 OUD。我们还根据 NOWS 诊断（无 OUD；OUD 无 NOWS；OUD 伴 NOWS）和产妇 MOUD 接受情况（无 OUD；OUD 无 MOUD；OUD 接受<90 天连续 MOUD；OUD 接受 90 天以上连续 MOUD）对该暴露因素进行分层。我们的结局是婴儿死亡率（<365 天死亡）。人口统计学调整后的逻辑回归分析评估了与比值比（OR）和 95%置信区间（CI）的关联。
产妇 OUD 与婴儿死亡率增加的几率相关（OR 1.43；95%CI 1.02-2.02）。在排除出生后<5 天死亡的婴儿（即 BEFORE 出现 NOWS 的临床表现）后，NOWS 诊断对婴儿死亡率的回归估计值没有显著差异。同样，在全样本中，母亲 MOUD 接受情况的回归估计值也没有显著差异。
产妇 OUD 与婴儿死亡率升高相关，且与 NOWS 或母亲 MOUD 治疗无关。未来的研究应调查潜在的机制，将产妇 OUD、NOWS、MOUD 治疗和婴儿死亡率联系起来，以便更好地为临床干预提供信息。
