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Maternal and Infant Characteristics Associated with Maternal Opioid Overdose in the Year Following Delivery
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November 13 2019
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Source: Addiction. 115(2):291-301
[PDF-506.89 KB]
Details:
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Alternative Title:Addiction
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Personal Author:
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Description:Background and Aims
Opioid-related overdose is increasingly linked to pregnancy-associated deaths, but factors associated with postpartum overdose are unknown. We aimed to estimate the strength of the association between maternal and infant characteristics and postpartum opioid-related overdose.
Design
Retrospective cohort study using a linked, population-level dataset.
Setting
Massachusetts, United States.
Participants
Women who delivered one or more live births from 2012–2014 (n=174,517).
Measurements
The primary outcome was opioid-related overdose in the postpartum year. We used multivariable logistic regression to explore the independent associations of maternal (demographics, substance use, pregnancy) and infant (gestational age, birthweight, neonatal abstinence syndrome (NAS)) characteristics with postpartum opioid overdose. Findings were stratified by maternal opioid use disorder (OUD) diagnosis.
Findings
There were 189 deliveries to women who experienced ≥1 opioid overdose in the first year postpartum (11/10,000 deliveries). Among women with postpartum opioid overdose, 46.6% had an OUD diagnosis within twelve months before delivery. In our adjusted model, maternal diagnosis of OUD (aOR 3.61, 95% CI 1.73–7.51) and prior non-fatal overdose (aOR 2.40, 95% CI 1.11–5.17) were most strongly associated with postpartum overdose. After stratifying by OUD status, infant diagnosis of NAS (OUD+ aOR 2.03, 95% CI 1.26–3.27; OUD- aOR 2.79, 95% CI 1.12–6.93), and high unscheduled healthcare utilization (OUD+ aOR 2.27, 95% CI 1.38–3.73; OUD- aOR 2.11, 95% CI 1.24–3.58) were positively associated with postpartum overdose in both groups.
Conclusion
Among women who delivered live infants in Massachusetts, USA between 2012 and 2014, maternal diagnosis of OUD, prior non-fatal overdose, infant diagnosis of NAS, and high unscheduled health care utilization appeared to be positively associated with postpartum opioid overdose. However, over half of postpartum overdoses in that period were to women without a diagnosis of OUD. Engagement in methadone or buprenorphine treatment in the month prior to delivery was not sufficient to reduce the odds of postpartum overdose.
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Subjects:
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Source:
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Pubmed ID:31692133
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Pubmed Central ID:PMC7066531
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Document Type:
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Funding:
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Volume:115
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Issue:2
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