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

产前阿片类药物暴露：母亲及其子女的出生、健康、社会经济和教育结果

• 批准号: 10158505
• 负责人: Lawrence M Berger
• 金额: $ 44.01万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-04 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10158505
• 关键词: Address; Affect; Age; Alcohols; Automobile Driving; Behavior Therapy; Big Data; Biological; Birth; Birth Records; Caring; Characteristics; Child; Child Abuse and Neglect; Child Development; Child Welfare; Childbirth; Clinical; Communities; Complement; Complex; Criminal Justice; Data; Demography; Diagnosis; Education; Employment; Epidemic; Exposure to; Family; Fertility; General Population; Health; Healthcare; Individual; Infant; Knowledge; Life; Link; Live Birth; Low Birth Weight Infant; Maternal and Child Health; Medicaid; Minority; Mothers; Multiple Partners; Neonatal Abstinence Syndrome; Newborn Infant; Opioid; Outcome; Pathway interactions; Phase; Policies; Population; Positioning Attribute; Postpartum Period; Pregnancy; Pregnant Women; Prevalence; Public Policy; Quasi-experiment; Reporting; Reproductive Health; Research; Research Support; Resources; Savings; Shapes; Siblings; Social Environment; Social Welfare; Social Work; Source; Time; Tobacco; United States National Institutes of Health; Update; Vulnerable Populations; Wisconsin; Woman; addiction; base; behavioral outcome; child protective service; cohort; combat; economic outcome; fetal; fetal opioid exposure; fetal substance exposure; foster care; healthcare community; improved outcome; maternal cocaine use; maternal opioid use; medication-assisted treatment; opioid epidemic; opioid exposure; opioid use; opioid use disorder; prenatal; prenatal exposure; prescription opioid; service programs; social; socioeconomics; treatment strategy; trend

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.

项目概要/摘要 过去十年中，产前接触处方药和其他阿片类药物的人数迅速增加，反映了巨大的趋势 美国普通人群使用阿片类药物的情况。在一些州，近四分之一的怀孕者会暴露在病毒中 处方阿片类药物； 60-80% 受影响的怀孕受医疗补助覆盖。此外，孕产妇人数的增加 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) 似乎与 推动大幅增加儿童保护服务 (CPS) 的参与。然而，产前阿片类药物的影响 与同时发生的因素无关，暴露对妊娠和儿童结局的影响仍不清楚。致地址 为了弥补这一差距，我们组装了一个多源纵向管理出生队列，将所有约 800,000 人的数据联系起来 2007 年至 2018 年威斯康星州的活产情况，其中包括约 350,000 名医疗补助覆盖的新生儿。通过链接数据 在个人层面，并每年更新每个数据源，我们可以识别和跟踪后续出生 （兄弟姐妹）并跟随越来越多的母亲和她们的孩子在十多年来的生活中展开。 我们独特的数据支持对个人因素以及医疗保健和医疗保健的影响进行多层次的检查 社区特征，需要更好地了解和解决阿片类药物流行的影响 关于妇女和她们的孩子。我们将使用基于回归和准实验的方法，并在地理空间上 知情分析，检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（包括 OUD 和婴儿 NAS）的年度有界患病率 2007 年至 2018 年威斯康星州医疗补助覆盖的出生情况，并描述受影响妇女的特征， 家庭及其社区，以及其中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，其行为和结果包括 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； c) 生殖， 母亲和儿童在产前时期的健康、社会、教育和经济成果 孩子生命的前 8 年； 3) 调查与相关的个人和社区层面的因素 母亲在产前和产后期间参与成瘾治疗，包括成瘾类型 治疗和治疗保留； 4) 估计参与成瘾治疗的合理因果影响 使用准实验设计，研究从孩子出生到 8 岁的孕产妇和儿童福祉。这 研究提出了 HHS 应对阿片类药物危机的五点战略，呼吁提供更好的数据和 更好的研究，补充了对生物途径和治疗策略的研究 由 Trans NIH 努力帮助消除成瘾长期 SM (HEAL) 计划。