Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure

Abstract

The health of women and children affected by opioid use disorder is a priority for state Medicaid programs. Little is known about longer-term outcomes among Medicaid-enrolled children exposed to opioids in utero. We examined well-child visit use and diagnoses of pediatric complex chronic conditions in the first five years of life among children with opioid exposure, tobacco exposure, or neither exposure in utero. The sample consisted of 82,329 maternal-child dyads in the Pennsylvania Medicaid program in which the children were born in the period 2008-11 and followed up for five years. Children with in utero opioid exposure had a lower predicted probability of recommended well-child visit use at age fifteen months (42.1 percent) compared to Reuse permissions at HealthAffairs.org.

Postpartum Treatment for Substance Use Disorder Among Mothers of Infants with Neonatal Abstinence Syndrome and Prenatal Substance Exposure

“…Few studies have examined linked mother–infant dyads affected by substances using Medicaid MAX data. 10 , 12 Linking mothers to their infants allowed us to observe that despite 82% of women having 7 or more months of enrollment in the year prior delivery, and about half having at least seven prenatal visits, fewer than half (44%) of women whose infants had NAS and/or PSE had a documented SUD or OUD in the prenatal period. Therefore, studies that rely only on maternal claims data may miss the majority of SUD diagnoses during pregnancy.…”

“…While many SUD treatment barriers for pregnant women have been described 8,9 and a prior study has examined treatment receipt among women with SUD and OUD in the 24 months surrounding delivery, 10 little is known about rates of SUD treatment for women in dyads affected by substance use in the immediate postpartum period (i.e., the start of the so-called fourth trimester) 11 or the sociodemographic and clinical characteristics associated with treatment receipt. Therefore, using an innovative but infrequently used approach of linking mother-infant dyads in Medicaid data, 10,12 we sought to (1) identify sociodemographic, health insurance, utilization, and clinical characteristics of mothers of infants with NAS and PSE who did or did not receive SUD treatment in the first 60 days postpartum, and (2) for those receiving treatment, describe the timing of postpartum treatment receipt. Building on literature describing factors associated with prenatal SUD treatment receipt, 13,14 we hypothesized that most mothers in substance-affected dyads would not receive timely postpartum treatment for SUD, and that race, urbanicity, duration of Medicaid enrollment, prenatal care attendance, and co-occurring mental health conditions would be associated with receipt of SUD treatment in the 60 days after delivery.…”

Ledipasvir plus sofosbuvir in pregnant women with hepatitis C virus infection: a phase 1 pharmacokinetic study

“…Future studies should carefully choose an appropriate control group because there are coexisting factors, including poverty, substance use, and opioid exposure, that could have an effect on safety outcomes. 27 …”

“…Future studies should carefully choose an appropriate control group because there are coexisting factors, including poverty, substance use, and opioid exposure, that could have an effect on safety outcomes. 27 The small sample size was directly related to the strict eligibility criteria for this study. First, the most substantial barrier to study recruitment and enrolment was the inability to confirm that women had chronic HCV infection (with a positive HCV test at least 6 months before enrolment) because many women were newly diagnosed during prenatal care screening.…”

Buprenorphine X-waiver exemption – beyond the basics for the obstetrical provider

“…The rise of opioid use disorder (OUD) is a national epidemic and has claimed more lives than the Vietnam War 1,2 . Among pregnant and postpartum individuals, OUD has more than quadrupled between since 2000 and is associated with far-reaching maternal, perinatal, and societal adverse outcomes, including significant years of life lost to overdose [3][4][5][6][7][8][9][10][11] . Buprenorphine is one of three medications approved by the Food and Drug Administration (FDA) for medication for OUD (MOUD) 12 .…”