731 - Impact of COVID-19 pandemic on Intrauterine Drug Exposure and Neonatal outcomes

Publication Number: 731.5341

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

Background: The COVID-19 pandemic has led to increased psychological stress and contributed to worse mental health outcomes. Isolation and decreased ability to cope with stressors have been reported to be associated with higher rates of illicit substance use particularly in vulnerable populations during pregnancy and childbirth. Recent studies have reported increased rates of illicit substance use during pregnancy. Studies on neonatal outcomes following intrauterine exposures to substance (IUSE) during the COVID-19 pandemic are limited.

Objective: To describe the impact of COVID-19 pandemic on neonatal intrauterine drug exposures and neonatal health outcomes.

Design/Methods: A single-center retrospective study including neonates delivered with positive screen for IUSE during a four-year study period between February 2018 and March 2022. Baseline characteristics, type & rates of substances exposed and short-term neonatal outcomes were compared across two epochs: Pre-COVID: February 2018- February 2020, and the COVID Pandemic period: March 2020-2022. Statistical significance was set at p< 0.05.

Results: A total of 975 neonates with IUSE were included, of which 359 (36.8%) neonates were pre-COVID and 616 (63.1%) born during the COVID time cohorts. There were higher rates of fentanyl (35.7% vs 0.28%), marijuana (25.3% vs 19.2%) and lower rates of methadone (7.9% vs 13.9%) during the pandemic time study period. Pandemic time cohort was associated with higher infants born with lower birth weight percentile (24.5% vs 27.4%) and with higher proportions of infants born small for gestational age ( < 10 percentile birth weight) (9,8% vs 6.9%). There was no difference in rates of neonatal intensive care unit admissions or length of hospital stay. There were no difference in medications used to treat neonatal abstinence syndrome except for no use of clonidine during the pandemic period. Rates of breast feeding increased during the pandemic period (22.1% vs 14.2%).

Conclusion(s): We report high rates of fentanyl and marijuana on neonatal urine drug screens during the pandemic period with decrease in methadone noted. This may suggest changes in trend of substance used during the pandemic. There were higher proportions of infants born small for gestational age and higher rates of breast feeding during the pandemic period. Further research is needed to evaluate these associations and evaluate long term health implications post-COVID-19 pandemic.

Table 1: Comparison of neonatal urine drug screen tests pre and during COVID-19 pandemic


Table 2: Comparison of neonatal outcomes with IUSE pre and during COVID-19 pandemic.