PRP127: Neonatal Outcomes in Prenatal Opioid Use: A multicenter cross-sectional study

Gregory Goshgarian, MPH, MSc; Neli Ragina, PhD, Director Research; Laura O'Brien, BS, MS; Rasha Jawad, BS; Robert Muterspaugh, BS, MSc; Robert Simons, BA; Danna Zevy, BSc, MSc; sudhakar Ezhuthachan, MD


Introduction: The National Institute on Drug Abuse (NIDA) has shown that from 2004-2014 there has been a five-fold increase in neonatal abstinence syndrome (NAS), with 32,000 infants born with this syndrome. Medication-assisted treatment (MAT) has proven utility in treating opioid use disorder. However, little is known about the differences in the effects of suboxone versus methadone, specifically, used as a MAT in pregnancy on neonatal outcomes. For this reason, we conducted a cross-sectional chart review to compare the neonatal outcomes of hospital length of stay (LOS), NAS scores, and NAS treatment duration, in infants born to mothers with opioid use disorder, on suboxone versus methadone, in three medical centers in Michigan.
Methods: The selection criteria include women, aged 18+, with diagnosed opioid use disorder in pregnancy receiving methadone or suboxone maintenance treatment. Subjects were identified using ICD-9 ICD-10 CM and CPT and codes for pregnancy, opioid addiction, maintenance therapy. We cross-referenced the aforementioned database with the neonate outcomes of NAS score, treatment duration, and LOS. Statistical analysis utilized independent samples t-test and multiple linear regression to compare the three outcomes between the methadone and suboxone groups.
Results: In the two medical centers, 422 women's medical records were evaluated. 144 (34.1%) women were on suboxone, and 231 (54.7%) were on methadone for MAT. The mean NAS score and LOS were found to be significantly higher (Mean Difference (MD) = 1.62 NAS points, p<0.01; MD LOS = 9.31, p<0.01), while while the mean NAS treatment duration was not found to be significantly different (p>0.05) in the methadone group versus suboxone. After controlling for maternal age, ethnicity, prenatal care, health insurance, smoking, alcohol use, parity, use of drugs, presence of medical complications, and delivery route, the MAT group of suboxone was found to be associated with a decreased neonate NAS score by 1.45 units NAS points (p<0.01) and a decreased neonate LOS by 4.77 days (p<0.05).
Discussion: The neonates of mothers prescribed suboxone for MAT have significantly lower NAS scores and shorter LOS. The results of the present study demonstrate that suboxone has the potential to be more effective treatment in reducing adverse neonatal outcomes in mothers who have opioid use disorder during pregnancy and on MAT.

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