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Maternal area of residence and outcomes for mother-infant dyads with perinatal opioid exposure
Pahl, A., Hu, Z., Young, L. W., Wong Ramsey, K., Whalen, B., Akshatha, A., Benninger, K., Fung, C., Howell, M. P., Markee, S. M., Das, A., Crawford, M., Trochinski, L., Greenberg, R., Smith, P. B., Ounpraseuth, S. T., Merhar, S., Devlin, L. A., & MacMillan, K. D. D. L. (2025). Maternal area of residence and outcomes for mother-infant dyads with perinatal opioid exposure. American Journal of Perinatology. Advance online publication. https://doi.org/10.1055/a-2622-3839
OBJECTIVE: To determine the relationship between maternal Social Deprivation Index (SDI), a composite measure of area level deprivation, and maternal characteristics and infant outcomes for mother-infant dyads with perinatal opioid exposure.
STUDY DESIGN: Post hoc secondary analysis of 1298 mother-infant dyads in the ESC-NOW study, a multicenter, stepped-wedge cluster-randomized controlled trial (2020-2022) conducted at 26 US study hospitals. The 2016 American Community Survey was used to develop SDI scores based on the maternal zip code of residence at the time of delivery. Outcomes evaluated included receipt of pharmacologic treatment for NOWS (PT), receipt of breastmilk during hospital stay, direct breastfeeding at discharge, discharge disposition, and length of stay for infants who received PT (LOS).
RESULTS: The median SDI score was 62 on a scale of 100. The high SDI group, with a score above the SDI median and more social deprivation, was less likely to receive adequate prenatal care or medication for opioid use disorder and more likely to be Black and/or Hispanic. The mean proportion of infants in the high SDI group were 6.2 percentage points (RR 0.89, 95%CI 0.80,0.98) less likely to receive breastmilk during the newborn hospitalization and 7.3 percentage points (RR 0.91, 95%CI 0.87,0.96) less likely to be discharged home with a biological parent. There was no difference between the high and low SDI groups in receipt of PT, direct breastfeeding at discharge, or LOS.
CONCLUSION: Mothers from high SDI communities with opioid exposure during pregnancy were less likely to receive the established standard of care and more likely to be Black and/or Hispanic. Infants born to these mothers were less likely to receive breastmilk and/or to be discharged home with a biological parent. These findings suggest that addressing social deprivation in high SDI communities may improve outcomes for opioid-exposed infants and their mothers.
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