The number of babies born in withdrawal from opioid drugs their mothers took during pregnancy has risen sharply in recent years. So has the number of children placed in foster care due to parental drug use.
If women are given medications to treat opioid use disorder during their pregnancy, however, they are significantly more likely to retain custody of their newborns after delivery, according to researchers at Vanderbilt University Medical Center (VUMC).
Yet a common medication for opioid use disorder, buprenorphine, is not widely approved for use in pregnant women because of limited data showing it improves outcomes, they noted in a research letter published July 12 in JAMA Health Forum.
“These findings further illustrate the importance of access to programs like (VUMC’s) Firefly clinic, which provides wraparound recovery services,” said Anna Morad, MD, director of the Newborn Nursery at Monroe Carell Jr. Children’s Hospital at Vanderbilt. “We see the positive impact of prenatal treatment and support for both mom and baby.”
“Infants are the fastest-growing age group in the U.S. foster system,” said Stephen Patrick, MD, MPH, professor of Pediatrics at Emory University School of Medicine in Atlanta. “At the same time, getting treatment for opioid use disorder in pregnancy is still far too challenging. We need a rapid expansion of treatment.”
Patrick, a former Vanderbilt faculty member who chairs the Department of Health Policy and Management at Emory University Rollins School of Public Health, is the research letter’s corresponding author. Co-authors include Morad and Lauren Presley, MSN, APRN, pediatric nurse practitioner in Monroe Carell’s Newborn Nursery and Primary Care Clinic.
Morad and Presley are among the clinical leaders in Firefly, a multidisciplinary outpatient program located at Vanderbilt Health One Hundred Oaks that provides services for women with substance abuse disorders and their children in partnership with TennCare, Tennessee’s Medicaid program.
The researchers studied all opioid-exposed infants born at Monroe Carell between March 1, 2018, and Jan. 1, 2022, who were at least 35 weeks gestational age and did not have a critical illness.
Infants whose mothers received medical treatment for opioid use disorder during their pregnancies were up to 40% more likely to be discharged home with their mothers than were infants whose mothers did not receive treatment.
This is important, not only because of the societal costs associated with foster care, but because, according to one recent review, children removed from the home due to parental drug use are likely to stay in foster care longer and are less likely than others to be reunited with their biological parents.
First author of the research letter, Alexandra Muhar, MD, is a former fellow in Neonatology-Perinatal Medicine at VUMC and currently a staff neonatologist at Children’s Minnesota Hospital in Minneapolis.
Other VUMC co-authors are Elizabeth McNeer, MS, senior biostatistician in the Department of Biostatistics; Sarah Loch, MPH, director of Research Operations at the Vanderbilt Center for Child Health Policy; and William Dupont, PhD, professor of Biostatistics and Health Policy.
The study was supported by grant number P50HD106446 from the Eunice Kennedy Shriver National Institute on Child Health and Human Development of the National Institutes of Health.
