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Sanusi A, Gray M, Xue Y, Mohr S, Curtis P, Dismukes J, Gentle S, Szychowski JM, Brocato B, Casey B, Harper L, Sinkey R. Delivery timing for the opioid-exposed infant. Am J Obstet Gynecol MFM 2022; 4:100719. [PMID: 35977700 PMCID: PMC10961100 DOI: 10.1016/j.ajogmf.2022.100719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence of opioid use disorder and medication-assisted treatment in pregnancy is increasing. Compared with term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome. It is unknown whether early term delivery compared with full or late-term delivery decreases the risk of neonatal opioid withdrawal syndrome. OBJECTIVE This study aimed to compare the neonatal outcomes among opioid-exposed infants born in the early, full, and late-term periods. STUDY DESIGN This was a retrospective cohort study of opioid-exposed pregnancies delivering at a single center from 2010 to 2017 at ≥37 weeks gestation. Participants with multiple gestations or fetal anomalies were excluded. Maternal opioid exposure was defined as prescription (including medication-assisted treatment) or nonprescription opioid use or a positive urine drug screen in pregnancy for opiates. The primary outcome was a neonatal composite of respiratory distress syndrome, neonatal sepsis, neonatal seizures, hypoxic ischemic encephalopathy, jaundice requiring treatment, 5-minute Apgar <5, neonatal intensive care unit admission, neonatal opioid withdrawal syndrome, or neonatal death. The secondary outcomes included individual components of the primary outcome, birthweight, need for and length of neonatal opioid withdrawal syndrome treatment, length of hospital admission, and maximum Finnegan scores. Early (37-<39), full (39-<41), and late (41-<42 weeks) term groups were defined by the American College of Obstetricians and Gynecologists. RESULTS Of 399 infants, 136 (34.1%), 229 (57.4%), and 34 (8.5%) were born in the early, full, and late-term periods, respectively. Two hundred and seventy patients (67.7%) received medication-assisted treatment for opioid use disorder, and the baseline characteristics were similar in all the groups except for history of intranasal heroin use, positive urine toxicology screen for heroin or any opiates, and delivery indication (P<.05). The primary composite outcome occurred in 313 (78.4%) neonates, and 296 (74.2%) neonates had neonatal opioid withdrawal syndrome. More than half (219 [54.9%]) of opioid-exposed neonates were admitted to the neonatal intensive care unit, and 160 (40.1%) required pharmacologic neonatal opioid withdrawal syndrome treatment for a mean duration of almost 3 weeks (19.0±16.1 days). There were no significant differences in the primary composite outcome, incidence of neonatal opioid withdrawal syndrome, or other secondary outcomes (except birthweight) between neonates born in the early, full, or late-term periods. CONCLUSION Although neonatal morbidity was frequent among opioid-exposed neonates, the incidence and severity of neonatal opioid withdrawal syndrome or other neonatal outcomes were not different between neonates delivered in the early, full, and late-term periods, suggesting that opioid-exposed infants may not benefit from early term delivery.
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Affiliation(s)
- Ayodeji Sanusi
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey).
| | - Meredith Gray
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
| | - Yumo Xue
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL (Mr Xue and Dr Szychowski)
| | - Sydney Mohr
- Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK (Dr Mohr)
| | - Peyton Curtis
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Mres Curtis and Dismukes)
| | - Jonathan Dismukes
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Mres Curtis and Dismukes)
| | - Samuel Gentle
- Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL (Dr Gentle)
| | - Jeff M Szychowski
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL (Mr Xue and Dr Szychowski)
| | - Brian Brocato
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
| | - Brian Casey
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
| | - Lorie Harper
- Department of Women's Health, The University of Texas at Austin, Dell Medical School, Austin, TX (Dr Harper)
| | - Rachel Sinkey
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey)
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