Prenatal Opioid Exposure: Birth, health, socioeconomic, and educational outcomes of mothers and their children

项目总结/摘要 在过去十年中，产前暴露于处方药和其他阿片类药物的迅速增加反映了戏剧性的趋势 在美国普通人群中使用阿片类药物。在一些州，近四分之一的怀孕妇女 处方阿片类药物; 60-80%受影响的怀孕是医疗补助覆盖的。此外，孕产妇死亡率上升， 阿片类药物使用障碍（OUD）、产前阿片类药物暴露和新生儿戒断综合征（NAS）似乎是 推动儿童保护服务（CPS）的参与大幅增加。然而，产前阿片类药物的影响 暴露对妊娠和儿童结局的影响，独立于共同发生的因素，仍然不清楚。解决 为了弥补这一差距，我们收集了一个多来源的纵向行政出生队列，将所有~ 80万人的数据联系起来。 从2007年到2018年，威斯康星州的活产人数，包括约350，000名医疗补助覆盖的出生人数。通过将数据链接到 在个人层面，每年更新每个数据来源，我们可以识别和跟踪随后的出生 （兄弟姐妹），并跟随越来越多的母亲和他们的孩子，因为他们的生活展开了十多年。 我们独特的数据支持对个体因素以及医疗保健和 社区特征，这是更好地了解和解决阿片类药物流行病的影响所必需的 妇女和她们的孩子。我们将使用基于回归和准实验的方法， 知情分析，以审查结果和可能影响结果的因素。我们的具体目标是：1） 估计产前阿片类药物暴露的有界年患病率，包括OUD和婴儿NAS， 2007-2018年威斯康星州医疗补助覆盖的分娩，并描述受影响妇女的特征， 家庭及其社区，以及随着时间的推移而发生的变化; 2）检查产前阿片类药物的关联 暴露，包括OUD和NAS，行为和结局包括a）不良妊娠和分娩 结果; B）虐待儿童报告，经证实的报告，和寄养条目;和c）生殖， 母亲和儿童在整个产前期间的健康、社会、教育和经济成果 （3）调查与儿童健康相关的个人和社区因素; 母亲在产前和产后期间参与戒毒治疗，包括 治疗和治疗保留;以及4）估计成瘾治疗参与的因果关系 使用准实验设计，对儿童出生至8岁期间的孕产妇和儿童福祉进行研究。这 研究解决了HHS对抗阿片类药物危机的5点战略，呼吁更好的数据和 更好的研究，并补充了对生物途径和治疗策略的研究， 帮助结束成瘾长期SM（HEAL）计划。

Project Summary/Abstract The rapid rise in prenatal exposure to prescription and other opioids over the last decade mirrors dramatic trends in opioid use across the general population of the US. In some states nearly one in four pregnancies are exposed to prescription opioids; 60-80% of affected pregnancies are Medicaid-covered. Moreover, the rise in maternal opioid use disorder (OUD), prenatal opioid exposure, and neonatal abstinence syndrome (NAS) appears to be driving a substantial increase child protective services (CPS) involvement. However, the impact of prenatal opioid exposure on pregnancy and child outcomes, independent of co-occurring factors, remains unclear. To address this gap, we have assembled a multi-source longitudinal administrative birth cohort that links data for all ~800,000 live births across Wisconsin, including ~350,000 Medicaid-covered births, from 2007 to 2018. By linking data at the individual-level, and updating each source of data annually, we can identify and track subsequent births (siblings) and follow a growing cohort of mothers and their children as their lives unfold over more than a decade. Our unique data support multilevel examination of individual factors, and the influence of health care and community characteristics, that is needed to better understand and address the effects of the opioid epidemic on women and their children. We will use regression-based and quasi-experimental methods, and geospatially informed analyses, to examine outcomes and factors which may influence outcomes. Our specific aims are: 1) Estimate the bounded annual prevalence of prenatal opioid exposure, including OUD and infant NAS, among all Medicaid-covered births in Wisconsin from 2007-2018, and describe the characteristics of affected women, families, and their communities, and changes therein over time; 2) Examine associations of prenatal opioid exposure, including OUD and NAS, with behaviors and outcomes including a) adverse pregnancy and birth outcomes; b) child maltreatment reports, substantiated reports, and foster care entries; and c) reproductive, health, social, educational, and economic outcomes for mothers and children, spanning the prenatal period through the first 8 years of the child’s life; 3) Investigate individual and community-level factors associated with maternal participation in addiction treatment during the prenatal and postpartum periods, including type(s) of treatment and treatment retention; and 4) Estimate plausibly causal effects of addiction treatment participation on maternal and child wellbeing spanning the child’s birth through age 8 using a quasi-experimental design. This research addresses the HHS 5-Point Strategy to Combat the Opioid Crisis, with a call for Better Data and Better Research, and complements the research into the biological pathways and treatment strategies enabled by the Trans NIH effort Helping to End Addiction Long-termSM (HEAL) Initiative.