Maternal OUD and NOWS increases risk of postneonatal infant mortality

In a new study led by Vanderbilt University Medical Center researchers, infants born to individuals who had opioid use disorder (OUD) during pregnancy or who developed neonatal opioid withdrawal syndrome (NOWS) faced a 54-64% greater risk of postneonatal death than infants without these exposures.

The study, led by Sarah Grossarth, MPH, and Dr. Margaret Adgent, PhD, MSPH, research associate professor in the Department of Health Policy, examined a large cohort of Tennessee Medicaid births, occurring between 2007 and 2018. Using administrative claims and vital records data, they assessed infants born to individuals with OUD documented during pregnancy and infants diagnosed with NOWS. They compared the risk of death among infants with and without these conditions to those that had neither.

margaret adgent, phd msph

“Postneonatal mortality, or infant deaths occurring after 28 days of age, is a rare but horrendous outcome. Our study demonstrated that infants born to individuals with OUD or who were diagnosed with NOWS are at increased risk for this outcome, regardless of whether these conditions were observed separately or in combination, suggesting that comprehensive support for high-risk families should extend beyond pregnancy and delivery, “ said Dr. Adgent, senior author of the study.

The study included more than 390,000 live births over the 11-year period, and reported an incidence rate of 3.47 postneonatal deaths per 1,000 person-years (p-y) among those without observed OUD or NOWS, mostly attributed to ill-defined causes such as sudden unexpected infant death.  This rate increased to 8.41 and 8.95 per 1,000 person-years for infants born to individuals with OUD, with and without NOWS diagnosis, respectively. In a small number of infants with NOWS, OUD in the birth parent was not documented.  Incidence in this group was also elevated, at 9.25 per 1,000 p-y.

“Our study also highlights that NOWS did not increase the risk for infant mortality above what was observed in OUD-only exposed pregnancies,” Adgent added.

Researchers noted that these data may reflect historical policies around opioid addiction, and that current trends towards expanding supportive care may yield improved outcomes in the future. Additional studies will be useful to understand how maternal use of OUD treatment medications impact these risks.

“Expanding diagnosis, treatment and support for individuals with OUD prenatally and postnatally, as well as their infants, may help prevent devastating outcomes in this vulnerable population,” the study concludes.

The research was funded in part by the U.S. Department of Health and Human Services, the National Institutes of Health. The team of investigators also include Sarah S. Osmundson MD MS, Andrew D. Wiese PhD MPH, Sharon Phillips MSPH, Amelie Pham, MD, Ashley A. Leech, PhD, Stephen W. Patrick MD MPH MS FAAP, Andrew J. Spieker, PhD, and Carlos G. Grijalva MD MPH.