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Health Equity/Community Health

Poster Session 3

(839) Unexpected UDS: Impact on Neonatal and Maternal Outcomes in Opioid Use Disorder

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Evaluate the effects of unexpected Urine Drug Screens (UDS) on neonatal and maternal outcomes in pregnant p</span>atients on Medications for Opioid Use Disorder (MOUD).

Study Design: Prospective cohort of pregnant patients on MOUD enrolled in a multidisciplinary treatment program between 2015 and May 2023. Patients had at least 2 prenatal visits with at least two UDS. Experimental group contained at least 2 unexpected UDS outcomes, while the control group had at least 2 expected UDS outcomes. Primary outcomes assessed were Neonatal Opioid Withdrawal Syndrome (NOWS). Secondary outcomes included prenatal care compliance, maternal obstetric outcomes, and birth weight. Categorical outcomes are compared between groups using Fisher’s exact tests. Quantitative data were analyzed using Poisson regression or two-sample t-tests with transformations included as appropriate.

Results:

266 patients met the inclusion criteria. 51 of 266 (19%) were on Buprenorphine prior to pregnancy vs 215 of 266 (81%) were started during pregnancy. 68 of 266 (26%) had at least 2 unexpected UDS outcomes vs 198 of 266 (74%) had expected UDS. The median buprenorphine dose at delivery was 12 mg [IQR: 8 to 16] vs 12 mg [8 to 16], P=.654. Demographic data was similar including overdose history.  



Hypertensive disorders were higher in the unexpected UDS group at 26.5% vs 15.2%, P=.044. NOWS treatment was similar in unexpected UDS at 56.7% vs 46.7%, P=.161, although the Finnegan score was higher in unexpected UDS 13.3 +/- 3.9 vs 12.1 +/- 3.9, P=.034. Prenatal and postpartum visits were lower in unexpected UDS group 14.6+/-7.9 v 18.9+/-7.1, P</span><.0001. Patients with unexpected UDS were less likely to be on buprenorphine at the time of delivery 77.9% v 94.4%, P=.0005. Rooming in and breastfeeding rates at discharge were lower in unexpected UDS at 45.3% v 64%, P=.012 and 7.4% vs 22.8%, P</span>=.004 respectively, Table.


Conclusion: Unexpected UDS results in pregnant patients with OUD were associated with higher rates of hypertensive disorders, lower prenatal and postpartum visit attendance, fewer on MOUD at delivery, and lower rates of mother-infant bonding.