With the rising opioid epidemic, literature has explored the effect of maintenance therapies and detoxification in opioid-dependent pregnancy. However, the outcomes of pregnancy in the opioid remit population have not yet been ascertained. This study will examine the effect of remission on maternal and fetal outcomes of pregnancy compared to a general population.METHODS:
A retrospective cohort study of 1,853,219 singleton gestations in California compared pregnancy outcomes of women with opioid remission to general population data. Maternal outcomes comprised cesarean deliveries, placental abruption, postpartum hemorrhage, and preeclampsia/eclampsia. Neonatal outcomes included preterm delivery (<37, <34, <32 weeks), intrauterine fetal demise, neonatal death (NND), respiratory distress syndrome, hypoglycemia, jaundice, asphyxia, neonatal seizures and neonatal abstinence syndrome (NAS). Hospital outcomes measured maternal and infant length of stay (LOS). Comparisons were performed using multivariate regression analyses, and Chi-square tests; a p-value of <0.05 was considered statistically significant.RESULTS:
Opioid remission showed a statistically significant increase in NND, NAS, maternal/infant LOS, and infant hospitalization cost. Pregnancy outcomes of women in opioid remission showed a significantly greater likelihood of maternal sepsis (OR 6.24, 95% CI 1.54-25.26), placental abruption (OR 3.34, 95% CI 2.48-4.50), and neonatal seizures (OR 7.19, 95% CI 3.39-15.24). Mean hospitalization was $7,474 more for the neonate (p <0.001). Maternal LOS (2.71 versus 2.48 days, p<0.001) and neonate LOS (4.66 versus 2.50, p<0.001) were substantially increased.CONCLUSION:
Remission has detrimental effects on pregnancy compared to a general population, and significantly increases NND, NAS and mother-baby dyad hospitals costs. For further analysis, a prospective trial is needed.