MORTALITY OF MOTHERS OF INFANTS BORN WITH NEONATAL ABSTINENCE SYNDROME: A?POPULATION-BASED TWENTY YEAR COHORT STUDY

摘要

BACKGROUND: With increasing rates of opioid use during pregnancy, the incidence of neonatal abstinence syndrome (NAS) is rising across North America. While perinatal outcomes for infants born with NAS have been well-described, little is known about long-term maternal health outcomes in this vulnerable population. OBJECTIVES: To describe all-cause mortality in mothers of infants born with NAS (NAS-mothers) and to compare their mortality rates and demographic characteristics to mothers of healthy infants (non-NAS mothers). DESIGN/METHODS: This population-based cohort study included mothers (aged 12 to 49?years) of 1,590,910 live births in Ontario, Canada (1994-2014) and used multiple health and demographic administrative databases. Infants born in hospital with and without NAS were identified through hospital birth records and linked to maternal healthcare and death certificate data. Poisson regression models estimated rate ratios of all cause mortality with 95% confidence intervals [CI’s]. RESULTS: 5130 NAS mothers and 1,585,780 non-NAS mothers were included with a median of 11.15 person years of follow-up. NAS mothers were younger (median age 27?years (IQR 23?– 32)?vs. 30 (IQR 26?– 34), more often ≤19?years of age (6.3% vs. 3.9% in non-NAS mothers), and had a larger proportion of the population living in the lowest neighborhood income quintile (40.8% vs. 22.6%) and in rural areas (18.5% vs. 10.0%). Only half (46.8%) of NAS-mothers received addiction medicine services in the year prior to delivery of their infant. The mortality rate per 1000 follow-up years of NAS-mothers was 4.64 (95% CI 4.45, 4.85) compared to 0.58 (95% CI 0.58, 0.59) among non-NAS mothers. The unadjusted rate ratio for mortality in NAS vs non-NAS mothers was 7.96 (95% CI 7.62, 8.31). Accident or injury-related deaths accounted for 27.8% of deaths in NAS mothers and only 8.7% of non-NAS mothers whereas cancer-related deaths accounted for 6.6% and 35.5% deaths in these groups, respectively. CONCLUSION: The eight-fold higher mortality rate observed in mothers of infants with NAS is concerning. These findings suggest a pressing need to provide added support for women with chronic opioid use both during and after pregnancy. Further study of cause-specific mortality and other health outcomes including injury and mental health of this population is warranted. Articles from Paediatrics & Child Health are provided here courtesy of Oxford University Press.