The Effects of Opioid Use during Pregnancy on Infant Health and Well-Being

Abstract

In this study, we estimate the first causal effects of in utero opioid exposure on infant health at birth and child protective services reports. We employ maternal fixed-effects models using linked administrative data capturing 259,723 infants born to 176,224 mothers enrolled in Medicaid between 2010 and 2019. Our preferred specifications suggest that neonatal abstinence syndrome and NICU admission bear strong associations with prenatal opioid exposure, concentrated on illicit and medication assisted treatment (MAT) exposure in the first and third trimesters. We find that prenatal opioid exposure is associated with increased CPS reports, low birth weight, preterm birth, and small for gestational age, though these measures are less sensitive with respect to the timing of exposure. While we detect relatively smaller effects of non-MAT prescription opioid exposure on NAS, NICU admission, low birthweight, these effects are not trivial, suggesting that medical professionals should consider balancing the potential for adverse side effects of infants with the benefits of pain management for pregnant women.

Keywords: Prenatal opioid exposure; child protective services; fetal development; in utero; infant health; medication-assisted treatment; opioids.

Figure A1:

Opioid deaths per 100,000 in Wisconsin compared to the United States Note: US data are from the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention and Wisconsin data are from the Wisconsin Department of Health Services.

Figure A2:

Stratified fractional exposure estimates during pregnancy with maternal fixed effects

Figure A3:

Stratified fractional exposure estimates during pregnancy with maternal fixed effects

Figure A4:

Stratified fractional exposure estimates during pregnancy with maternal fixed effects

Figure A5:

Stratified fractional exposure estimates during pregnancy with maternal fixed effects

Figure 1:

Estimated effects of the fraction of trimesters opioid exposed on NAS Note: See notes on Tables 1 and 2 for data description and measure definitions and note on Table 3 for model specifications. Outcomes include narrow and broad neonatal abstinence syndrome (NAS), across three specifications: maternal fixed effects (MFE) estimated using sibling pairs and linear probability models (LPM) estimated using sibling pairs ‘sib’ and the full sample.

Figure 2:

Estimated effects of the fraction of trimesters opioid exposed on birthweight and gestational age Note: See notes on Tables 1 and 2 for data description and measure definitions and note on Table 4 for model specifications. Outcomes include low birthweight (<2,500g) and preterm birth (< 37 weeks), across three specifications: maternal fixed effects (MFE) estimated using sibling pairs and linear probability models (LPM) estimated using sibling pairs ‘sib’ and the full sample.

Figure 3:

Estimated effects of the fraction of trimesters opioid exposed on health at birth Note: See notes on Tables 1 and 2 for data description and measure definitions and note on Table 4 for model specifications. Outcomes include small for gestation age (< 10^th percentile) and five-minute APGAR score <7, across three specifications: maternal fixed effects (MFE) estimated using sibling pairs and linear probability models (LPM) estimated using sibling pairs ‘sib’ and the full sample.

Figure 4:

Estimated effects of the fraction of trimesters opioid exposed on measures of child wellbeing Note: See notes on Tables 1 and 2 for data description and measure definitions and note on Table 4 for model specifications. Outcomes include CPS report within seven days and NICU admission, across three specifications: maternal fixed effects (MFE) estimated using sibling pairs and linear probability models (LPM) estimated using sibling pairs ‘sib’ and the full sample.