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Dudley J, Gabrielson SMB, O'Connor AB, Ahrens KA. Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016-2022. J Perinatol 2024; 44:1104-1110. [PMID: 38267636 DOI: 10.1038/s41372-024-01882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available. STUDY DESIGN We used hospital discharge data to estimate the annual prevalence of maternal OUD and NAS between 2016 and 2022. In addition, we used birth certificate-linked Medicaid data to estimate related trends among Medicaid enrollees. RESULT From 2016 to 2022, the prevalence of maternal OUD decreased from 35.3 to 18.8 per 1000 deliveries and the prevalence of NAS decreased from 33.2 to 14.0 per 1000 newborns (linear trend p values <0.01). Decreasing trends were also found among Medicaid enrollees. CONCLUSION In Maine between 2016 and 2022, there was a decrease in maternal OUD and NAS diagnoses recorded in administrative datasets. These findings should be interpreted with caution due to changes in how OUD and NAS diagnoses are recorded and COVID-related changes in healthcare utilization.
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Affiliation(s)
- Julia Dudley
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
| | - Sarah M B Gabrielson
- Department of Pediatrics, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, USA
| | - Alane B O'Connor
- Perinatal Addiction Medicine, Maine Medical Center, Portland, ME, USA
| | - Katherine A Ahrens
- Muskie School of Public Service, University of Southern Maine, Portland, ME, USA.
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Lisonkova S, Wen Q, Richter LL, Ting JY, Lyons J, Mitchell-Foster S, Oviedo-Joekes E, Muraca GM, Bayrampour H, Cattoni E, Abrahams R. Neonatal abstinence syndrome and infant mortality and morbidity: a population-based study. Front Pediatr 2024; 12:1394682. [PMID: 39081925 PMCID: PMC11286564 DOI: 10.3389/fped.2024.1394682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/20/2024] [Indexed: 08/02/2024] Open
Abstract
Background Infant health among newborns with neonatal abstinence syndrome (NAS) has been understudied. We examined infant mortality and hospitalizations among infants diagnosed with NAS after birth. Methods All live births in British Columbia (BC), Canada, for fiscal years from 2004-2005 to 2019-2020, were included (N = 696,900). NAS was identified based on International Classification of Diseases, version 10, Canadian modification (ICD-10-CA) codes; the outcomes included infant death and hospitalizations during the first year of life, ascertained from BC linked administrative data. Generalized estimating equation models were used to adjust for maternal factors. Results There were 2,439 infants with NAS (3.50 per 1,000 live births). Unadjusted for other factors, infant mortality was 2.5-fold higher in infants with vs. without NAS (7.79 vs. 3.08 per 1,000 live births, respectively) due to increased post-discharge mortality NAS (5.76 vs. 1.34 per 1,000 surviving infants, respectively). These differences diminished after adjustment: adjusted odds ratio (AOR) for infant death was 0.85 [95% confidence interval (CI): 0.52-1.39]; AOR for post-discharge death was 1.75 (95% CI 1.00-3.06). Overall, 22.3% infants with NAS had at least one hospitalization after post-neonatal discharge, this proportion was 10.7% in those without NAS. During the study period, discharge to foster care declined from 49.5% to 20.3% in infants with NAS. Conclusion Unadjusted for other factors, infants with NAS had increased post-discharge infant mortality and hospitalizations during the first year of life. This association diminished after adjustment for adverse maternal and socio-medical conditions. Infants with NAS had a disproportionately higher rate of placement in foster care after birth, although this proportion declined dramatically between 2004/2005 and 2019/2020. These results highlight the importance of implementing integrated care services to support infants born with NAS and their mothers during the first year of life and beyond, even though NAS itself is not independently associated with increased infant mortality.
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Affiliation(s)
- Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Qi Wen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay L. Richter
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Y. Ting
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Janet Lyons
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sheona Mitchell-Foster
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
- Northern Medical Program, University of British Columbia, Prince George, BC, Canada
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Giulia M. Muraca
- Departments of Obstetrics and Gynecology, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Hamideh Bayrampour
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Eric Cattoni
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ronald Abrahams
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Ulrich SE, Sugg MM, Desjardins MR, Runkle JD. Disparities in spatiotemporal clustering of maternal mental health conditions before and during the COVID-19 pandemic. Health Place 2024; 89:103307. [PMID: 38954963 DOI: 10.1016/j.healthplace.2024.103307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/15/2024] [Accepted: 06/23/2024] [Indexed: 07/04/2024]
Abstract
Mounting evidence indicates the worsening of maternal mental health conditions during the COVID-19 pandemic. Mental health conditions are the leading cause of preventable death during the perinatal and postpartum periods. Our study sought to detect space-time patterns in the distribution of maternal mental health conditions in pregnant women before (2016-2019) and during (2020-2021) the COVID-19 pandemic in North Carolina, USA. Using the space-time Poisson model in SaTScan, we performed univariate and multivariate cluster analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), maternal mental disorders of pregnancy (MDP), suicidal thoughts, and suicide attempts during the pre-pandemic and pandemic periods. Clusters were adjusted for age, race, and insurance type. Significant multivariate and univariate PMAD, SMI, and MDP clustering persisted across both periods in North Carolina, while univariate clustering for both suicide outcomes decreased during the pandemic. Local relative risk (RR) for all conditions increased drastically in select locations. The number of zip code tabulation areas (ZCTAs) included in clusters decreased, while the proportion of urban locations included in clusters increased for non-suicide outcomes. Average yearly case counts for all maternal mental health outcomes increased during the pandemic. Results provide contextual and spatial information concerning at-risk maternal populations with a high burden of perinatal mental health disorders before and during the pandemic and emphasize the necessity of urgent and targeted expansion of mental health resources in select communities.
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Affiliation(s)
- Sarah E Ulrich
- Department of Geography and Planning, P.O. Box 32066, Appalachian State University, Boone, NC, 28608, USA.
| | - Margaret M Sugg
- Department of Geography and Planning, P.O. Box 32066, Appalachian State University, Boone, NC, 28608, USA.
| | - Michael R Desjardins
- Department of Epidemiology & Spatial Science for Public Health Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, 151 Patton Avenue, Asheville, NC, 28801, USA
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Fu W, McClymont E, Av-Gay G, Dorling M, Atkinson A, Azampanah A, Elwood C, Sauvé L, van Schalkwyk J, Sotindjo T, Money D. Retrospective Cohort Study on the Impact of the COVID-19 Pandemic on Pregnancy Outcomes for Women Living With HIV in British Columbia. J Acquir Immune Defic Syndr 2024; 95:411-416. [PMID: 38489490 DOI: 10.1097/qai.0000000000003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/18/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND For pregnant women living with HIV (WLWH), engagement in care is crucial to maternal health and reducing the risk of perinatal transmission. To date, there have been no studies in Canada examining the impact of the COVID-19 pandemic on pregnant WLWH. METHODS This was a retrospective cohort study assessing the impact of the pandemic on perinatal outcomes for pregnant WLWH using data from the Perinatal HIV Surveillance Program in British Columbia, Canada. We compared maternal characteristics, pregnancy outcomes, and clinical indicators related to engagement with care between a prepandemic (January 2017-March 2020) and pandemic cohort (March 2020-December 2022). We investigated preterm birth rates with explanatory variables using logistic regression analysis. RESULTS The prepandemic cohort (n = 87) had a significantly (P < 0.05) lower gestational age at the first antenatal encounter (9.0 vs 11.8) and lower rates of preterm births compared with the pandemic cohort (n = 56; 15% vs 37%). Adjusted odds of preterm birth increased with the presence of substance use in pregnancy (aOR = 10.45, 95% confidence interval: 2.19 to 49.94) in WLWH. There were 2 cases of perinatal transmission of HIV in the pandemic cohort, whereas the prepandemic cohort had none. CONCLUSIONS The pandemic had pronounced effects on pregnant WLWH and their infants in British Columbia including higher rates of preterm birth and higher gestational age at the first antenatal encounter. The nonstatistically significant increase in perinatal transmission rates is of high clinical importance.
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Affiliation(s)
- Winnie Fu
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Elisabeth McClymont
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Gal Av-Gay
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Marisa Dorling
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Andrea Atkinson
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | | | - Chelsea Elwood
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Laura Sauvé
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Julie van Schalkwyk
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Tatiana Sotindjo
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Deborah Money
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
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Echols A, Collins S, Akbarali S, Dronamraju R, Uesugi K. Public Health Approaches to Perinatal Substance Use: An Overview of Strategic Directions. Matern Child Health J 2023; 27:1-4. [PMID: 37930561 PMCID: PMC10691984 DOI: 10.1007/s10995-023-03792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Amani Echols
- Association of Maternal & Child Health Programs, Washington DC, USA.
| | - Stacy Collins
- Association of Maternal & Child Health Programs, Washington DC, USA
| | - Sanaa Akbarali
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Ramya Dronamraju
- Association of State and Territorial Health Officials, Arlington, VA, USA
| | - Keriann Uesugi
- Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, MD, USA
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