Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery

• DOI: 10.1111/add.14825
• Publication Date: 2019-11-06T09:43:44Z
• Authors: Timothy Nielsen; Dana Bernson; Mishka Terplan; Sarah E. Wakeman; Amy M. Yule; Pooja K. Mehta; Monica Bharel; Hafsatou Diop; Elsie M. Taveras; Timothy E. Wilens; Davida M. Schiff
• Keywords: Adult; neonatal abstinence syndrome; Datasets as Topic; Information Storage and Retrieval; Reproductive health and childbirth; Maternal; Midwifery; Medical and Health Sciences; Clinical and health psychology; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Pregnancy; Health Sciences; Opiate Substitution Treatment; Humans; Conditions Affecting the Embryonic and Fetal Periods; postpartum; non-fatal; Retrospective Studies; Pediatric; Public health; Prevention; Psychology and Cognitive Sciences; Postpartum Period; Substance Abuse; Infant, Newborn; Infant; opioid use disorder; Newborn; Opioid-Related Disorders; 3. Good health; Opiate Overdose; Good Health and Well Being; Massachusetts; Female; Public Health; pregnancy; women; overdose; Live Birth; Neonatal Abstinence Syndrome; Facilities and Services Utilization

AbstractBackground and AimsOpioid‐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.DesignRetrospective cohort study using a linked, population‐level data set.SettingMassachusetts, United States.ConclusionAmong 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, more than 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.ParticipantsWomen who delivered one or more live births from 2012 to 2014 (n = 174 517).MeasurementsThe 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.FindingsThere were 189 deliveries to women who experienced ≥ 1 opioid overdose in the first year postpartum (11 of 10 000 deliveries). Among women with postpartum opioid overdose, 46.6% had an OUD diagnosis within 12 months before delivery. In our adjusted model, maternal diagnosis of OUD [adjusted odds ratio (aOR) = 3.61, 95% confidence interval (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 health‐care 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.