REVIEW OF: Singleton R et al, J Addict Med 2022;16(6):e366–e373

STUDY TYPE: Retrospective chart review

As the prevalence of opioid use disorder (OUD) continues to rise, so too does the rate of opioid use during pregnancy. Once born, many of these infants never get the chance to go home with a biological parent and are instead referred to the child welfare system, leaving many pregnant patients reluctant to seek OUD treatment. This trend is especially pronounced in minority populations, with minority children disproportionately represented in the child welfare system due to parental substance use. We know that the use of medications for opioid use disorder (MOUD) is associated with a host of positive health outcomes, but does avoiding this treatment paradoxically increase the likelihood that a baby will get to go home with their biological parent?

The authors of this recent study were interested in the impact of MOUD among pregnant Native American and Alaska Native patients. They conducted a retrospective chart review at three Alaskan hospitals and identified 193 patients with OUD who had recently given birth to a full-term infant. About half of the patients (47%) were receiving an MOUD at the time of delivery (buprenorphine or methadone), while the other half were using non-prescribed opioids such as heroin. 

Overall, 70% of the infants were discharged home with their biological parent(s), 13% were discharged to a relative, 13% went directly into foster care, and a few were transferred to another hospital or addiction treatment unit. Crucially, patients taking an MOUD were more likely to leave the hospital with their baby (OR=3.9; 95% confidence interval [CI]=1.5–9.2; p=0.005). On the flip side, prenatal heroin use was associated with a lower likelihood of the baby going home with a biological parent (OR=0.11; 95% CI=0.04–0.28; p=0.0001). Proper prenatal care was associated with a greater likelihood that the baby would be discharged with a biological parent (OR=3.7; 95% CI=1.5–9.2; p=0.005) and also increased the likelihood that the patient would receive an MOUD while pregnant (p<0.001). 

CARLAT TAKE

Some have feared that MOUD treatment during pregnancy could lead to infants being placed in foster care, especially among minority populations. On the contrary, at least in this study, MOUD was associated with an increased likelihood that newborns would go home with a biological parent. This study underscores the importance of good prenatal care and MOUD treatment for our pregnant patients.