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

项目摘要/摘要 在过去的十年中，产前接触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，近四分之一的怀孕被曝光。 到处方阿片类药物；60%-80%的受影响怀孕是由医疗补助覆盖的。此外，产妇死亡率的上升 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 推动儿童保护服务(CPS)参与的大幅增加。然而，产前阿片类药物的影响 与共同发生的因素无关，对怀孕和孩子结果的暴露仍不清楚。致信地址 这一差距，我们已经收集了一个多来源的纵向管理生育队列，将所有~800,000 从2007年到2018年，威斯康星州的活产儿，包括大约350,000名医疗补助覆盖的新生儿。通过在以下位置链接数据 在个体层面，每年更新每个数据来源，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，因为他们的生活在十多年里展开。 我们独特的数据支持对个人因素的多层次检查，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的影响所必需的 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，以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的有限年度流行率，其中包括OUD和婴儿NAS 2007年至2018年威斯康星州医疗补助覆盖的出生情况，并描述了受影响女性的特征， 家庭及其社区及其随时间的变化；2)检查产前阿片类药物的相关性 暴露，包括OUD和NAS，有行为和结果，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、 母亲和儿童在产前期间的健康、社会、教育和经济结果 通过儿童生命的前8年；3)调查与以下方面有关的个人和社区因素 产前和产后母亲对成瘾治疗的参与，包括类型(S) 治疗和治疗保留；以及4)可信地估计参与成瘾治疗的因果影响 使用准实验设计，对婴儿从出生到8岁期间的母婴健康状况进行研究。这 研究涉及HHS应对阿片类药物危机的5点战略，呼吁更好的数据和 更好的研究，并补充对生物途径和治疗策略的研究 由Trans NIH努力帮助结束成瘾的长期SM(Hear)倡议。

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.