Five-Year Outcomes Among Medicaid-Enrolled Children With In Utero Opioid Exposure

Abstract

The health of women and children affected by opioid use disorder is a priority for state Medicaid programs. Little is known about longer-term outcomes among Medicaid-enrolled children exposed to opioids in utero. We examined well-child visit use and diagnoses of pediatric complex chronic conditions in the first five years of life among children with opioid exposure, tobacco exposure, or neither exposure in utero. The sample consisted of 82,329 maternal-child dyads in the Pennsylvania Medicaid program in which the children were born in the period 2008-11 and followed up for five years. Children with in utero opioid exposure had a lower predicted probability of recommended well-child visit use at age fifteen months (42.1 percent) compared to those with tobacco exposure (54.1 percent) and those with neither exposure (55.7 percent). Children with in utero opioid exposure had a predicted probability of being diagnosed with a pediatric complex chronic condition similar to that among children with tobacco exposure and those with neither exposure (20.4 percent, 18.7 percent, and 20.2 percent, respectively). Our findings were consistent when we examined a subgroup of opioid-exposed children identified as having neonatal opioid withdrawal symptoms.

Keywords: Abstinence; Access and use; Children's health; Chronic disease; Emergency departments; Health conditions; Health policy; Medicaid; Opioid use disorder; Pediatric chronic conditions; Pregnancy; Well-child visits.

Exhibit 2

Average predicted probability of having recommended well-child visits among children in Pennsylvania Medicaid, by in utero exposure to opioids or tobacco and diagnosis of neonatal abstinence syndrome (NAS) SOURCE Authors’ analysis of data about 82,329 Medicaid-enrolled children born in the period 2008–11 and followed up for five years. NOTES In utero opioid exposure and in utero tobacco exposure are defined in the notes to exhibit 1. NAS is defined as having a diagnosis of a constellation of withdrawal symptoms. At least six well-child visits are recommended in the first fifteen months of life, and an annual well-child visit is recommended at ages three, four, and five years. The results are from weighted population-averaged multivariable logistic regression models that controlled for maternal and child health characteristics. The error bars indicate 95% confidence intervals.

Exhibit 4

Average predicted probability of developing a pediatric complex chronic condition (CCC) by age 5 years among children in Pennsylvania Medicaid, by in utero exposure to opioids or tobacco and diagnosis of neonatal abstinence syndrome (NAS) SOURCE Authors’ analysis of data about 82,329 Medicaid-enrolled children born in the period 2008–11 and followed up for five years. NOTES In utero opioid exposure and in utero tobacco exposure are defined in the notes to exhibit 1. NAS is defined as having a diagnosis of a constellation of withdrawal symptoms. The results are from weighted population-averaged multivariable logistic regression models that controlled for maternal and child health characteristics. The error bars indicate 95% confidence intervals.