In the Journals

Maternal substance abuse disorders linked to adverse infant outcomes

Infants born to mothers with substance abuse disorders are more likely to be born preterm with a low birth weight, have a wide variety of medical concerns and have a higher risk of mortality, according to findings published in The Journal of Pediatrics.

“Despite the growing problem of maternal addiction and associated adverse neonatal outcomes, our ability to monitor and understand the details of this major public health issue has been limited by the lack of robust data systems,” Sunah S. Hwang, MD, MPH, from the department of neonatology at Children’s Hospital Colorado and the department of pediatrics at the University of Colorado School of Medicine, and colleagues wrote. “To date, epidemiological studies about maternal [substance abuse disorders] and infant outcomes have primarily been cross-sectional, lacking longitudinal analysis of outcomes of individual mothers and infants.”

“Moreover, the identification of maternal substance abuse disorders has been limited to the use of self-reported surveys or medical record diagnoses, if present,” they continued. “Thus, the current analyses of perinatal risk associated with maternal [substance abuse disorders] may not be accurate.”

To examine the relationship between mothers’ substance abuse disorders while pregnant and adverse outcomes and hospital readmissions in infants, the researchers conducted an analysis in which data collected between 2002 and 2010 were gathered from two statewide datasets. The connections between maternal substance abuse disorders and infant outcomes as well as rehospitalization, were assessed using generalized estimating equations.

In 2009, the rate of maternal substance abuse disorders increased from 19.4 to 31.1 per 1,000 live births. Neonates who were exposed to maternal substance use in utero had a greater risk of preterm birth (adjusted OR = 1.85; 95% CI, 1.75-1.96). These infants were also more likely to have a low birthweight (aOR = 1.94; 95% CI, 1.80-2.09). Furthermore, infants who were exposed to maternal substance abuse also were more likely to experience restricted intrauterine growth, as well as cardiac, respiratory, neurologic, infectious, hematologic and feeding/nutrition concerns.

Data revealed an increased risk of prolonged hospital stays and higher mortality (aOR range = 1.26-3.80), in addition to a higher likelihood of rehospitalization (aOR = 1.10; 95% CI, 1.04-1.17); however, within the first year of life, these neonates were less likely to experience observational hospital stays (aOR = 0.90; 95% CI, 0.82-099) and less likely to utilize ED care (aOR = 0.87; 95% CI, 0.83-0.90).

“Given that nearly all infants born to [mothers with substance abuse disorders] were at significantly greater risk for adverse neonatal and infant outcomes compared with [mothers without substance abuse disorders], mothers should be given appropriate counseling during pregnancy about these risks,” Hwang and colleagues wrote. “With the recent increase in opioid prescriptions as well as the legalization of marijuana in several states, mothers may not be receiving a consistent message about the potential risks of prenatal exposure to their infants.”

“Furthermore, with increased use of these substances in the adult population, providers may not routinely screen all pregnant women, and, thus, the degree of information about fetal exposure and potential perinatal risks is minimized or not known,” they continued. – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Infants born to mothers with substance abuse disorders are more likely to be born preterm with a low birth weight, have a wide variety of medical concerns and have a higher risk of mortality, according to findings published in The Journal of Pediatrics.

“Despite the growing problem of maternal addiction and associated adverse neonatal outcomes, our ability to monitor and understand the details of this major public health issue has been limited by the lack of robust data systems,” Sunah S. Hwang, MD, MPH, from the department of neonatology at Children’s Hospital Colorado and the department of pediatrics at the University of Colorado School of Medicine, and colleagues wrote. “To date, epidemiological studies about maternal [substance abuse disorders] and infant outcomes have primarily been cross-sectional, lacking longitudinal analysis of outcomes of individual mothers and infants.”

“Moreover, the identification of maternal substance abuse disorders has been limited to the use of self-reported surveys or medical record diagnoses, if present,” they continued. “Thus, the current analyses of perinatal risk associated with maternal [substance abuse disorders] may not be accurate.”

To examine the relationship between mothers’ substance abuse disorders while pregnant and adverse outcomes and hospital readmissions in infants, the researchers conducted an analysis in which data collected between 2002 and 2010 were gathered from two statewide datasets. The connections between maternal substance abuse disorders and infant outcomes as well as rehospitalization, were assessed using generalized estimating equations.

In 2009, the rate of maternal substance abuse disorders increased from 19.4 to 31.1 per 1,000 live births. Neonates who were exposed to maternal substance use in utero had a greater risk of preterm birth (adjusted OR = 1.85; 95% CI, 1.75-1.96). These infants were also more likely to have a low birthweight (aOR = 1.94; 95% CI, 1.80-2.09). Furthermore, infants who were exposed to maternal substance abuse also were more likely to experience restricted intrauterine growth, as well as cardiac, respiratory, neurologic, infectious, hematologic and feeding/nutrition concerns.

Data revealed an increased risk of prolonged hospital stays and higher mortality (aOR range = 1.26-3.80), in addition to a higher likelihood of rehospitalization (aOR = 1.10; 95% CI, 1.04-1.17); however, within the first year of life, these neonates were less likely to experience observational hospital stays (aOR = 0.90; 95% CI, 0.82-099) and less likely to utilize ED care (aOR = 0.87; 95% CI, 0.83-0.90).

“Given that nearly all infants born to [mothers with substance abuse disorders] were at significantly greater risk for adverse neonatal and infant outcomes compared with [mothers without substance abuse disorders], mothers should be given appropriate counseling during pregnancy about these risks,” Hwang and colleagues wrote. “With the recent increase in opioid prescriptions as well as the legalization of marijuana in several states, mothers may not be receiving a consistent message about the potential risks of prenatal exposure to their infants.”

“Furthermore, with increased use of these substances in the adult population, providers may not routinely screen all pregnant women, and, thus, the degree of information about fetal exposure and potential perinatal risks is minimized or not known,” they continued. – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.