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Am J Perinatol 2026; 43(03): 383-395
DOI: 10.1055/a-2622-3839
Original Article

Maternal Area of Residence and Outcomes for Mother–Infant Dyads with Perinatal Opioid Exposure

Authors

  • Adrienne Pahl 

    1   Department of Pediatrics, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, Vermont

  • Zhuopei Hu

    2   Department of Biostatistics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas

  • Leslie W. Young

    1   Department of Pediatrics, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, Vermont

  • Kara Wong Ramsey

    3   Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii

  • Bonny L. Whalen

    4   Pediatric Hospital Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire

  • Akshatha Akshatha

    3   Department of Pediatrics, Kapiolani Medical Center for Women and Children, Honolulu, Hawaii

  • Kristen L. Benninger

    5   Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio

  • Camille M. Fung 

    6   Department of Pediatric Neonatology, University of Utah School of Medicine, Salt Lake City, Utah

  • Meghan P. Howell

    7   Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana

  • Sofia Markee

    8   Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico

  • Abhik Das 

    9   Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina

  • Margaret M. Crawford

    9   Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina

  • Lillian Trochinski

    9   Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina

  • Rachel G. Greenberg 

    10   Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

  • Brian Smith

    10   Department of Pediatrics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina

  • Songthip T. Ounpraseuth

    2   Department of Biostatistics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas

  • Stephanie L. Merhar

    11   Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

  • Lori A. Devlin

    12   Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky

  • Kathryn Dee L. MacMillan 

    4   Pediatric Hospital Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
    • for the Eunice Kennedy Shriver NICHD, Neonatal Research Network, the NIH ECHO Program, IDeA States Pediatric Clinical Trials Network

Funding This work was funded by the U.S. Department of Health and Human Services, National Institutes of Health, and Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant nos.: 2UG10D024947-03, 3U2COD023375-06S1, 3U2COD023375-07S2, U10 HD053089, U24 OD024957, UG1 HD27853, UG1 HD36790, UG1 HD68278, UG1 HD87226, UG1 OD024954, UG1 OD024955, UG1 OD024959, UL1 TR105, and UL1 TR77).
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Abstract

Objective

Determine the relationship between maternal Social Deprivation Index (SDI), a composite measure of area-level deprivation, and maternal characteristics and infant outcomes for mother–infant dyads with perinatal opioid exposure.

Study Design

Post hoc secondary analysis of 1,298 mother–infant dyads in the ESC-NOW study, a multicenter, stepped-wedge cluster-randomized controlled trial (2020–2022) conducted at 26 U.S. study hospitals. The 2016 American Community Survey was used to develop SDI scores based on the maternal zip code of residence at the time of delivery. Outcomes evaluated included receipt of pharmacologic treatment for neonatal opioid withdrawal syndrome (PT), receipt of breastmilk during hospital stay, direct breastfeeding at discharge, discharge disposition, and length of stay for infants who received PT (length of hospital stay, LOS).

Results

The median SDI score was 62 on a scale of 100. The high SDI group, with a score above the SDI median and more social deprivation, was less likely to receive adequate prenatal care or medication for opioid use disorder and more likely to be Black and/or Hispanic. The mean proportion of infants in the high SDI group was 6.2% points (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.80, 0.98) less likely to receive breastmilk during the newborn hospitalization and 7.3% points (RR: 0.91; 95% CI: 0.87, 0.96) less likely to be discharged home with a biological parent. There was no difference between the high and low SDI groups in receipt of PT, direct breastfeeding at discharge, or LOS.

Conclusion

Mothers from high SDI communities with opioid exposure during pregnancy were less likely to receive the established standard of care and more likely to be Black and/or Hispanic. Infants born to these mothers were less likely to receive breastmilk and/or to be discharged home with a biological parent. Targeting interventions to mitigate the impact of social deprivation in high SDI communities may improve outcomes for opioid-exposed infants and their mothers.

Key Points

  • Living in an area with high social deprivation was associated with differences in health outcomes.

  • Mothers were more likely to be Black and/or Hispanic.

  • Mothers were less likely to receive the standard of care during pregnancy.

  • Infants were less likely to receive breastmilk and/or be discharged home with a biological parent.

  • Interventions designed to address community social deprivation may improve outcomes.

Keywords

social deprivation - neonatal Abstinence syndrome - opioid - perinatal care - neonatal opioid withdrawal syndrome - residence characteristics - sociodemographic factors

Authors' Contributions

Z.H. and S.T.O. had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design, acquisition, analysis, and interpretation of data were done by A.P., Z.H., L.W.Y., S.T.O., S.L.M., L.A.D. and K.D.L.M. Drafting of the manuscript was done by A.P., Z.H., L.W.Y., K.W.R., B.L.W., A.A, K.L.B., C.M.F., M.P.H., S.M., A.D., M.M.C., L.T., R.G.G., B.S., S.T.O., S.L.M., L.A.D. and K.D.L.M.




Publication History

Received: 08 May 2025

Accepted: 26 May 2025

Accepted Manuscript online:
28 May 2025

Article published online:
16 June 2025

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