The High Cost of Opioid Use in Pregnancy

Abstract

Background: Numerous investigators have highlighted the need to integrate opioid use disorder (OUD) treatment with maternity care. Since data first became available in 2014, Montgomery County (Ohio) has experienced the highest rates of OUD and unintended opioid overdose deaths in the state. This paper examines the demographics and costs of medical treatment for pregnant women with OUD and their newborns with prenatal exposure to opioids (PEO). Methods: The study involved a retrospective records review of all newborns born between May 1, 2016, and April 30, 2017, at a large, urban medical center. Newborns with PEO were matched with a control group by mother's type of insurance, race/ethnicity, method of birth, and maternal parity. Results: Establishing which of the pregnant women should be diagnosed with OUD and be included in the study group was inordinately challenging. Ultimately, of the 3841 infants birthed during the study period, 131 (3.4%) were iden-tified as being born to mothers with OUD. Significantly more mothers with OUD were White and on Medicaid. Only 25 (19.2%) mothers with OUD engaged in treatment for substance use. Compared to the control group, newborns with PEO were much more likely (71.4% versus 25.4%) to be admitted to the NICU and had much longer lengths of stay in both the NICU (mean of 14.4 versus 4.1 days) and hospital (16.9 versus 5.8 days), resulting in dramatic increases in health care cost. Conclusion: These data underscore the need for a comprehensive, systematic approach to OUD and PEO and affirm the government as a major stakeholder in the care of infants born to these women.