Addressing Opioid Use Disorder to Improve Maternal and Infant Health

As part of CDC’s five-point strategy to prevent opioid overdoses and harms, the Division of Reproductive Health (DRH) is working to prevent, identify, and improve access to treatment of opioid use disorder (OUD) among pregnant and postpartum women and women of reproductive age. Learn more about opioid use during pregnancy.

Efforts to address opioid use disorder to improve maternal and infant health include conducting surveillance; building state, local and tribal capacity; and supporting providers, health systems and healthcare payers. With support from CDC’s National Center of Injury Prevention and Control (NCIPC), DRH expanded its opioid-related activities in 2018 and 2019.

chart icon Conducting Surveillance and Research

The Pregnancy Risk Assessment Monitoring System (PRAMS) collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy.  In 2016-2017, PRAMS added a marijuana and prescription drug supplement in selected states that included indicators of opioid use and misuse. As part of DRH’s work, 32 states are now receiving funding to collect, analyze and disseminate data on non-fatal opioid use and misuse. In addition, seven states have been funded to conduct a follow-up survey of moms and their babies to examine postpartum use of opioids, maternal and infant health, developmental outcomes, and use of health care and social services.

Maternal Mortality Review Committees (MMRCs) get complete, detailed data on maternal deaths, and use these data to develop recommendations for preventionexternal icon.  As part of DRH’s expanded work, six state MMRCs are receiving funding to review all pregnancy-associated overdose deaths in their state.

Improve accuracy of neonatal abstinence syndrome (NAS) reporting by validating cases identified in hospital discharge data with medical records and collaborating with federal partners and the Council for State and Territorial Epidemiologists to develop standard surveillance definitions for use by jurisdictions.

• Positive Predictive Value of Administrative Data for Neonatal Abstinence Syndrome. Faouzi I. Maalouf, William O. Cooper, Shannon M. Stratton, Judith A. Dudley, Jean Ko, Anamika Banerji, Stephen W. Patrick
• Assessing the Burden of Neonatal Abstinence Syndrome: Validation of ICD-9-CM Data, Florida 2010–2011Phillips-Bell GS, Holicky A, Lind JN, Sappenfield WM, Hudak ML, Petersen E, Anjorhin S, Watkins SM, Creanga AA, Correia JA. Journal of Public Health Management & Practice.

map icon Building State, Local, and Tribal Capacity for Prevention

The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI)is a Learning Community that supports state teams to implement policies and programs to address opioid use among pregnant and postpartum women, and infants prenatally exposed to opioids.

Perinatal Quality Collaboratives (PQCs) are state or multi-state networks of teams working to improve the quality of care for mothers and babies, identifying areas for improvement, making changes as quickly as possible and monitoring uptake and impact.  CDC funds 13 PQCs to improve the quality of perinatal care in their states, including efforts to improve outcomes related to maternal OUD and neonatal abstinence syndrome.

CDC’s Maternal and Child Health Epidemiology Program assigns epidemiologists and fellows to state, local, and tribal agencies to support epidemiologic research and provide scientific information to strengthen maternal and child health activities. These assignees work on a wide range of issues, including maternal OUD and neonatal abstinence syndrome.

Rapid response for technical assistance requests from states and tribes. Upon request, CDC conducts investigations to examine maternal use of illegal and prescription drugs and its impacts.

• • From Washington: Maternal drug use and its effect on neonates: a population-based study in Washington State.external icon

users class icon  Supporting Providers, Health Systems, and Payers

Comparing and validating screening tools to detect substance use among pregnant women at prenatal care visits. Five commonly used screening instruments for detecting substance use in the primary care setting were compared and validated against biological samples (e.g., urine) from pregnant women to assess how well each screening instrument performs. These findings will be used to inform the development of a screening tool to improve care for pregnant women.

Examining knowledge, attitudes, and practices among OB-GYNs. In collaboration with the American College of Obstetricians and Gynecologists, DRH collected information about provider knowledge, attitudes and beliefs regarding maternal opioid use, their screening and treatment practices for pregnant and postpartum patients with opioid use disorder, barriers to screening and treating pregnant and postpartum patients for opioid use, and coordination with pediatric staff on NAS. This information will be used to develop tools and resources and improve treatment and referral to care.

Developing and disseminating tools to support Pediatricians to screen for substance use among new moms. In collaboration with the American Academy of Pediatrics, this project will review and disseminate best practices for implementing screening, including how to link to treatment, and share this information with primary care pediatricians.

Developing objective measurement of withdrawal signs. There is no national standard of care to identify or manage withdrawal signs in newborns. Current assessment of withdrawal signs in newborns is subjective. However, some signs can be objectively measured. In partnership with CDC’s Small Business Innovation Research program, DRH is supporting efforts to create technology to objectively measure withdrawal signs in infants.