727 - Association of Fentanyl Use in Pregnancy and Neonatal and Maternal Health Outcomes

Publication Number: 727.3784

Olivia Venvertloh, Creighton University School of Medicine, Phoenix, AZ, United States; Megan A. Witsoe, Creighton University School of Medicine, Scottsdale, AZ, United States; Sara C. Esteves, Creighton University School of Medicine, Scottsdale, AZ, United States; Laura M. Cogua, Creighton University School of Medicine, Phoenix, AZ, United States; Jenna K. Moses, Creighton University School of Medicine, Phoenix, AZ, United States; Vanuyen Pham, Creighton University School of Medicine, Phoenix, AZ, United States; Paul Kang, Creighton University School of Medicine Phoenix, Phoenix, AZ, United States; Hemananda Muniraman, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States

Background: The rate of fentanyl use as an illicit substance in the United States has continued to increase alarmingly since the inception of the opioid epidemic in the 1990s. Nearly two-thirds of deaths related to drug overdose are attributed to fentanyl and its related products. Illicit use of fentanyl in pregnancy has seen a similar increase in the last few years. The adverse effects of fentanyl use during pregnancy on maternal, fetal, and neonatal outcomes are emerging with recently published epidemiological studies.

Objective: To evaluate the association between maternal fentanyl use disorder and neonatal and maternal health outcomes.

Design/Methods: A single-center retrospective study included pregnant women admitted with a positive history and urine screen for illicit substance use during pregnancy over a four-year study period between February 2018 and March 2022. Maternal and neonatal outcomes following intrauterine fentanyl exposure were described and compared with those without fentanyl exposure using multivariable linear and logistic regression adjusting for other significant variables. A two-sided p-value < 0.05 was considered significant.

Results: 1179 pregnant women and 974 neonates’ urine drug screens were positive for illicit substances during the study period of which 199 (16.8%) women and 186 (19%) neonates tested positive for fentanyl. Rates of abruption were higher in pregnant mothers positive for fentanyl (aOR: 2.47) (Table 1). For neonatal outcomes, a positive fentanyl maternal screen was associated with increased risk of intrauterine growth restriction (aOR: 2.24) but no differences in growth anthropometrics were noted at birth. Higher rates of neonatal intensive care admission (aOR: 3.47), neonatal abstinence syndrome (aOR: 5.97), longer length of stay (β: 3.45), respiratory distress (aOR: 1.80) and decreased use of maternal milk (aOR: 0.20) were noted in neonates who tested positive for fentanyl (Table 2).

Conclusion(s): Maternal fentanyl use during pregnancy was associated with adverse short-term outcomes in both pregnant women and neonates with increased risk for placental abruption, intrauterine growth restriction, higher rates of neonatal abstinence syndrome, respiratory distress, need for neonatal intensive care admission and longer length of hospital stay. Further studies are needed to evaluate long-term outcomes.

Table 1: Association between Fentanyl Use and Maternal Outcomes
Multivariable Logistic Regression adjusting for maternal age, race Marital Status, insurance status, income status, number of prenatal visits, gravida, and maternal gestational age.

Table 2: Association between Fentanyl and Neonatal Outcomes
1 Multivariable Linear Regression adjusting for maternal age, race, marital status, insurance status, income status, number of prenatal visits, gravida, and maternal gestational age.
2 Multivariable Logistic Regression adjusting for maternal age, race, marital status, insurance status, income status, number of prenatal visits, gravida, and maternal gestational age.