Congratulations to Abigail Crocker, PhD, Assistant Professor of Mathematics and Statistics, who will be presenting a part of her CTS PHD thesis at the American Academy of Pediatrics Annual Conference in New Orleans in October.
Crocker
A, Geller W, Metayer J, Littenberg B, Meyer M. Educational Outcomes of Children
Born to Women in Treatment for Opioid Use Disorder. Abstract 672527. American
Academy of Pediatrics, Annual Conference. Oct 2019.
Purpose:
Opioid use in pregnancy continues to increase. The data on long term outcomes of children exposed to maternal medication assisted therapy (MAT) during pregnancy are limited, with most studies including all types of in utero opioid exposure in the outcomes. The goal of this project was to examine the educational outcome of children exposed to methadone or buprenorphine in the context of maternal comprehensive treatment for opioid use disorder compared to control children without known exposure to opioids. We hypothesized that, if comprehensive perinatal care with MAT is safe and effective, outcomes will be similar in the two groups.
Methods:
We identified children delivered to mothers that received Medicaid insurance in a single hospital between 2006-2010 exposed to MAT (n=429) and not exposed to MAT or opioids (n=1009) and were in the state educational database. The educational outcome was assessed by linking health records to data stewarded by the state Agency of Education. Deliveries less than 37 weeks gestation or major congenital anomalies were excluded. The primary outcome was whether a child received an Individualized Education Plan (IEP) in kindergarten or not. We compared the proportion with an IEP in each group using multivariate logistic regression to control for potential confounders. Secondary outcomes included third grade IEP utilization and whether a child was scored as “proficient” by a standardized test at grade three. Potential confounders included sex, birth weight, maternal age, maternal education level, in utero tobacco exposure, and free or reduced lunch eligibility status. Institutional Review Board approval was obtained for all analyses.
Results:
We found no statistically significant difference in kindergarten or third grade IEP utilization (MATE: 15.5%; MATNo 15%; OR = 1.1, 95% CI: 0.91, 1.34; P=0.33) or standardized test proficiency at grade 3 (proficient MATE: 35%; MATNo 38%, OR = 1.18; 95% CI: 0.89, 1.47; P=0.28) between children born to women receiving comprehensive perinatal care with MAT and an economically similar comparison group, while controlling for potential confounders.
Conclusions:
In spite of concerns about the long-term impact of in utero opioid exposure, maternal use of prescribed opioids as part of comprehensive, coordinated perinatal care did not impair educational outcomes in the early grades. Clinicians and policy makers at the state and federal levels should be encouraged to support access to coordinated, comprehensive perinatal care with MAT as an effective secondary prevention strategy with positive long- and short-term impacts.
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