Prenatal Opioid and Substance Exposure
Neonatal Abstinence Syndrome and Other Infant and Child Outcomes Related to Prenatal Opioid and Substance Exposure: NCBDDD Activities
As a part of CDC’s 5 key strategies for preventing opioid overdoses and opioid-related harms, CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD) is working to address the impact of the opioid crisis on women who are pregnant, infants, and children. NCBDDD aims to better understand neonatal abstinence syndrome (NAS) and other health outcomes in infants and children related to substance use in pregnancy. NCBDDD uses findings to improve the care of mothers and their children and help them thrive.
NCBDDD’s Activities to Support CDC’s 5 Key Strategies
Conduct surveillance and research
Neonatal Abstinence Syndrome (NAS) Surveillance
In fiscal year 2019, NCBDDD received $2 million from Congress to better understand NAS. With these funds, NCBDDD is supporting public health partners working with state and territorial health departments to monitor NAS. A standard surveillance case definition will be used. This will allow more consistent and comparable data to be gathered across geographic areas.
In fiscal year 2020, CDC is forecasting a funding opportunityexternal icon to strengthen capacity of existing birth defects surveillance programs to respond to emerging threats to mothers and babies. Goals include
- Expanding to include NAS
- Making data collection faster
- Using electronic health records and other methods to better monitor birth defects and NAS
- Using data to improve health of affected people.
This work builds on NCBDDD’s collaboration with March of Dimes, which supported work in three states to adapt existing birth defects surveillance methods to conduct surveillance for NAS. The results showed that it is feasible to monitor NAS building on the experience of birth defects surveillance.
MAT-LINK: MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment of Opioid Use Disorder during Pregnancy
NCBDDD received funding for MAT-LINK for 3 years (June 2019–2022) through the Patient-Centered Outcomes Research Trust Fund (PCORTF)external icon. This project is administered by the Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation. MAT-LINK will build a surveillance network to collect data across 3–5 clinical sites. They will collect data on maternal, infant, and child health outcomes related to treatments for opioid use disorder during pregnancy. Project objectives include
- Comparing health outcomes across opioid use disorder treatment regimens to inform best practice guidelines for women who are pregnant and infants; and
- Developing a data platform to collect linked maternal and infant data.
Examining Longer-term Outcomes among Children with NAS
A pilot study from the Tennessee Department of Health, supported by CDC and March of Dimesexternal icon, looked at developmental outcomes among children with a history of NAS. They found that these children were more likely to have a developmental delay or speech or language impairment in early childhood compared to children without a history of NAS. This was the first study to look at educational outcomes among children with a history of NAS in the United States. Additional research is needed to better understand the longer-term outcomes of prenatal opioid exposure for children with a history of NAS.
Evaluating Possible Associations between Prescription Opioid Use during Pregnancy and Birth Defects
In two case-control studies of birth defects (one using data from the National Birth Defects Prevention Studyexternal icon and the other using data from the Slone Birth Defects Studyexternal icon), researchers identified possible associations between exposure to prescription opioid medication just before or during early pregnancy and the occurrence of certain birth defects. In a review articleexternal icon summarizing existing literature (including the two aforementioned articles), researchers identified birth defects that may be related to prescription and illicit opioid use or misuse during pregnancy, including
Additionally, in a 2019 study, researchers found that the number of babies born with gastroschisis (a birth defect of the abdominal wall) was higher in U.S. counties with high opioid prescription rates than in counties with low opioid prescription rates. More research is needed to determine if prescription and illicit opioid exposure in pregnancy increases the risk of birth defects.
Evaluating Possible Associations between Opioid Use during Pregnancy and Developmental Disabilities
An analysis of the Study to Explore Early Development (SEED) found that mothers who were prescribed opioids just before becoming pregnant were more likely to have a child with autism spectrum disorder or a child with other developmental disabilities and some autism symptoms. This study is among the first to look at associations between the prescribing of opioids during pregnancy and autism spectrum disorder and other developmental disabilities. More research is needed to better understand developmental outcomes among children whose mothers were exposed to prescription or illicit opioids up to 3 months before and during pregnancy.
Monitoring and Reporting the Occurrence of Prescription Opioid Use in Women of Reproductive Age and Women who are pregnant
NCBDDD researchers used data from two large insurance claim datasets to look at opioid prescriptions filled at outpatient pharmacies by women of reproductive age. Researchers found that each year during 2008–2012, 28% of women with private health insurance and 39% of women with Medicaid filled a prescription from a healthcare provider for an opioid medication. The most commonly prescribed opioids were hydrocodone, codeine, and oxycodone. In addition, the frequency of opioid prescription claims was consistently higher among Medicaid-insured women than commercially insured women. More work is needed to promote interventions to reduce opioid prescriptions among women when safer alternative treatments are available.
Build state, local, and tribal capacity
Evaluation of State-mandated Reporting of NAS in Six States
NCBDDD collaborated with other CDC and HHS staff to identify laws that mandate NAS reporting for public health surveillance and evaluate their impact. These laws helped states estimate the number of babies diagnosed with NAS in their area. They also helped to identify opportunities for treatment and prevention for mothers and babies and plan for needed services. These findings can help other states thinking about laws requiring NAS reporting for public health surveillance.
Rapid Assistance with Data Collection and Analysis in Pennsylvania
The Pennsylvania Department of Healthexternal icon requested the assistance of NCBDDD, in the form of an Epi-Aid, to assess the quality of hospital data on NAS reported in Pennsylvania. To accomplish these objectives, data from the medical records of about 500 infants with possible NAS (along with medical records for mothers of infants meeting Pennsylvania’s NAS case definition) were collected at five hospitals across Pennsylvania in 2019. Analyses are ongoing.
Local Health Department Surge Support
Through NCBDDD’s Local Health Department Initiative, a contractual field assignee was placed in Allegheny County, Pennsylvania. In this role, she supported the county health department in responding to the local opioid crisis. NCBDDD and the Allegheny County Health Departmentexternal icon seek to improve public health outreach to mothers and their infants affected by the opioid crisis. Through a partnership with the Association of State and Territorial Health Officials, and in collaboration with CDC’s Division of Reproductive Health, NCBDDD is working to place additional contractual assignees in selected local health departments to provide surge support to respond to the opioid crisis.
Support providers, health systems, and payers
Clinical and Public Health Partnerships
NCBDDD collaborates with clinical and public health organizations to address the impact of the opioid and substance use crisis on women who are pregnant, infants, and children:
- American Academy of Pediatrics (AAP)external icon
- American College of Obstetricians and Gynecologists (ACOG)external icon
- Association of Maternal and Child Health Programs (AMCHP)external icon
- Association of Public Health Laboratories (APHL)external icon
- Association of State and Territorial Health Officials (ASTHO)external icon
- Council of State and Territorial Epidemiologists (CSTE)external icon
- March of Dimesexternal icon
- National Association of County and City Health Officials (NACCHO)external icon
- National Organization on Fetal Alcohol Syndrome (NOFAS)external icon
Empower consumers to make safe choices
Treating for Two
NCBDDD and partners began Treating for Two to improve the health of women and babies by identifying the safest treatment options for common conditions experienced before, during, and after pregnancy. With this initiative, CDC aims to do the following:
- Support research about health outcomes related to medicine use during pregnancy
- Provide guidance on medicine use in pregnancy
- Help women and healthcare professionals make treatment decisions together based on the best available information
Communicating with Healthcare Providers and Women who are pregnant: Reducing Stigma
Communication around pregnancy and opioid use can be challenging. Therefore, it is important for communicators to avoid words and messages that are stigmatizing or ineffective. NCBDDD has collaborated with March of Dimes in qualitative studies around communication and messaging for healthcare providers and women who are pregnant. We are learning more about the knowledge and attitudes of women and healthcare providers regarding opioid use during pregnancy and NAS, as well as perceptions of harm from medicine and other substances.
Partner with public safety
Collaboration with Child Welfare around Prenatal Alcohol and Other Drug Exposures
NCBDDD collaborates with the Children’s Bureau of the Administration for Children and Families (ACF)external icon to improve the health and developmental outcomes of children with prenatal substance exposures in the child welfare system by promoting appropriate identification, referrals, interventions, and education. This project also aims to reduce the risk of repeating the cycles of abuse and neglect and build the infrastructure to monitor the type and resources needed to care for this population.
For additional resources and information related to opioid exposure during pregnancy, please visit CDC’s Opioid Use During Pregnancy webpages.