Opioid use disorder (OUD) among pregnant individuals is a key public health crisis in need for improved longitudinal surveillance efforts. There has been more than a four-fold increase in the number of deliveries impacted by (OUD) in pregnancy and a sevenfold increase in the rate of neonatal opioid withdrawal syndrome (NOWS) between 2000 to 2016 in the United States (U.S.). The standard of care for pregnant individuals with OUD is to receive medication for opioid use disorder (MOUD) with associated improved pregnancy and perinatal outcomes. In recent years, new treatment modalities for OUD have emerged with limited data on pregnancy, neonatal, or childhood outcomes. In addition, polysubstance use impacts many of individuals with OUD, including continued non-prescribed drug use and psychiatric medication use for co-occurring mental health conditions. The impact of these polysubstance exposures on pregnancy and neonatal outcomes is unclear. Lastly, NOWS is a highly variable condition, impacted by the changes in hospital treatment strategies and numerous clinical factors including type of MOUD and polypharmacy exposures. Rigorous data on the long-term outcomes of opioid-exposed infants is limited, with concerns about behavioral issues, school challenges, attentional difficulties, and risk for developmental challenges. There is a need for detailed patient-level electronic health record (EHR) data from a large cohort to be able to account for all prenatal substance exposures and infant variables that can influence the long-term outcomes of these children through a comprehensive longitudinal surveillance program.
Our team at Boston Medical Center (BMC), a Component A institution, is comprised of nationally recognized experts in the field of OUD in pregnancy and NOWS with a decade-long track record of clinical innovation, research excellence, and dissemination of best practices across the country. We hope to continue to partner with the CDC on this surveillance project, assisting with advancing the science and dissemination of best practice data.
With our exposures and outcomes of interest being (1) opioid-exposure in pregnancy, (2) polysubstance exposure in pregnancy, and (3) NOWS, we aim to achieve the following outcomes over the 1-year performance period: (1) Improve surveillance data collection; (2) Increase access and availability of EHR data; (3) Improve timely reporting of key exposures and outcomes; (4) Improve surveillance system data that can be leveraged for emerging threats; (5) Increase awareness by CDC of the data and how they are shared; (6) Increase implementation of prevention activities and dissemination; (7) Expand and strengthen our collaborative network; and (8) Improve data structure and increase interoperability.
We will accomplish this goals by implementing key strategies and activities including: (1) Coordinating with the CDC and other recipients to identify opportunities for collaboration; (2) Engaging in data modernization initiatives; (3) Establishing collaborations with internal and external partners to strengthen data collection and translation of the data; (4) Monitoring and evaluating data for completeness, accuracy, and timeliness; (5) Using the data for prevention activities; and (6) Abstract and extracting EHR data from pregnant person-infant dyads from pregnancy through 6 years of age for surveillance and submitting this data to the CDC.
The end result will be the establishment of a robust longitudinal surveillance database to assist us with the establishment of best practice data that can then be disseminated across the U.S. to improve the care of pregnant individuals with OUD, polysubstance exposure, and infants with NOWS.
