Maternal and Infant Characteristics Associated with Maternal Opioid Overdose in the Year Following Delivery

Details

• Alternative Title:
  Addiction
• Personal Author:
  Nielsen, Timothy ; Bernson, Dana ; Terplan, Mishka ; Wakeman, Sarah E. ; Yule, Amy M. ; Mehta, Pooja K. ; Bharel, Monica ; Diop, Hafsatou ; Taveras, Elsie M. ; Wilens, Timothy E. ; Schiff, Davida M.
• 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.
  
  
• Subjects:
  Adult Article Cohort Studies Datasets As Topic Facilities And Services Utilization Female Humans Infant Infant, Newborn Information Storage And Retrieval Live Birth Massachusetts Maternal Neonatal Abstinence Syndrome Non-fatal Opiate Overdose Opiate Substitution Treatment Opioid-Related Disorders Opioid Use Disorder Overdose Postpartum Postpartum Period Pregnancy Retrospective Studies Women

  More +
• Source:
  Addiction. 115(2):291-301
• Pubmed ID:
  31692133
• Pubmed Central ID:
  PMC7066531
• Document Type:
  Journal Article
• Funding:
  K12 DA043490/DA/NIDA NIH HHS/United States ; K23 DA048169/DA/NIDA NIH HHS/United States ; K24 DA030443/DA/NIDA NIH HHS/United States ; K12 DA000357/DA/NIDA NIH HHS/United States ; U38 OT000143/OT/OSTLTS CDC HHS/United States ; K24 DK105989/DK/NIDDK NIH HHS/United States ; 1U38OT000143-04/CC/CDC HHS/United States
• Volume:
  115
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:48fa9b39430e66411cf9eb0941da9ea6a26ddf67080e3010e84b4eec0b380633
• Download URL:
  https://stacks.cdc.gov/view/cdc/85857/cdc_85857_DS1.pdf
• File Type:
  [PDF - 506.89 KB ]