436 - Correlation between maternal dose of medication for opioid use disorder and drug levels in maternal urine and infant cord toxicology analysis

Publication Number: 436.4192

Nicole M. Connolly, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer McAllister, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Scott Wexelblatt, Cincinnati Children's Hospital Medical Center, Mason, OH, United States; Cathy Grisby, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Chunyan Liu, Cincinnati Children's Hospital, Cincinnati, OH, United States; Shelley Ehrlich, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Rates of opioid use disorder (OUD) among pregnant women and neonatal opioid withdrawal syndrome (NOWS) remain a major public health issue in the United States. Maternal or infant toxicology analysis at time of delivery is often used to identify infants at risk for NOWS. Few studies have evaluated the correlation between maternal dose of medication for opioid use disorder (MOUD) and drug levels in maternal and infant toxicology testing.

Objective: To determine the correlation between MOUD levels from maternal urine samples, infant umbilical cord samples, and maternal MOUD dose on admission.

Design/Methods: We performed a prospective study of maternal-infant dyads recruited from a regional MOUD program from 2020 to 2023. Information regarding maternal urine and cord toxicology results, MOUD dosing, maternal and infant demographics, and receipt of opioid treatment for NOWS was collected. Spearman correlation coefficients were used for the pairwise relationships between continuous variables and scatter plots overlayed with linear regression fit were done for visual presentation.

Results: Of the 108 mothers and 112 infants in the study, there were 92 maternal urine samples and 92 cord samples collected. Fifty-six mothers were taking buprenorphine and 52 taking methadone for MOUD. There was good agreement between maternal urine levels and cord levels for both methadone and norbuprenorphine with Spearman correlation coefficients of 0.403 and 0.602, respectively. Additionally, there was good agreement between admission dose of buprenorphine and maternal urine and cord levels of norbuprenorphine with Spearman correlation coefficients of 0.484 and 0.423, respectively. There was no correlation between admission dose and maternal urine and cord levels of methadone.

Conclusion(s): Maternal urine and cord levels of both methadone and buprenorphine had good correlation. Admission dose of buprenorphine, but not methadone, correlated well with maternal urine and cord levels.

Spearman Correlation Coefficients between pairs of drug levels from different sources


Scatter plot of admission dose (mg) and drug level in urine/cord samples (ng/mL) of methadone/norbuprenorphine, colored by need for opioid treatment for NOWS