Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016–2022

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objective

To estimate trends in maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) in Maine using the most recent data available.

Study design

We used hospital discharge data to estimate the annual prevalence of maternal OUD and NAS between 2016 and 2022. In addition, we used birth certificate-linked Medicaid data to estimate related trends among Medicaid enrollees.

Result

From 2016 to 2022, the prevalence of maternal OUD decreased from 35.3 to 18.8 per 1000 deliveries and the prevalence of NAS decreased from 33.2 to 14.0 per 1000 newborns (linear trend p values <0.01). Decreasing trends were also found among Medicaid enrollees.

Conclusion

In Maine between 2016 and 2022, there was a decrease in maternal OUD and NAS diagnoses recorded in administrative datasets. These findings should be interpreted with caution due to changes in how OUD and NAS diagnoses are recorded and COVID-related changes in healthcare utilization.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Prevalence of maternal opioid use disorder (OUD) at delivery hospitalization among Maine residents according to MHDO hospital discharge data, by primary payer, 2016–2022 (n = 77,046).
Fig. 2: Prevalence of neonatal abstinence syndrome (NAS) at birth hospitalization among Maine residents according to MHDO hospital discharge data, by primary payer, 2016–2022 (n = 79,138).
Fig. 3: Prevalence of opioid use disorder (OUD) during pregnancy1 and treatment status among Maine Medicaid-enrolled women according to birth certificate-linked Medicaid data, by delivery year, 2016–2022 (n = 37,995).
Fig. 4: Prevalence of neonatal abstinence syndrome (NAS) overall by maternal opioid use disorder (OUD) during pregnancy1 and treatment status among Maine Medicaid-enrolled infants and mother-infant pairs according to birth certificate-linked Medicaid data, by delivery year, 2016–2022 (n = 37,491 infants and n = 36,117 mother-infant pairs).

Similar content being viewed by others

Data availability

The data use agreements with the Maine Office of Data, Research, and Vital Statistics and the Maine Health Data Organization, and the cooperative agreement with the Office of MaineCare Services prohibit distribution of any patient-level data; thus, the data used for this study are not made publicly available. Data can be requested from the Maine Department of Health and Human Services (https://hcai.ca.gov/) and from the Maine Health Data Organization (https://mhdo.maine.gov/) by qualified researchers.

References

  1. Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW. Neonatal abstinence syndrome and maternal opioid-related diagnoses in the U.S., 2010–2017. JAMA. 2021;325:146. https://doi.org/10.1001/jama.2020.24991.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder documented at delivery hospitalization—United States, 1999–2014. MMWR Morb Mortal Wkly Rep. 2018;67:845–9. https://doi.org/10.15585/mmwr.mm6731a1.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ko JY, Hirai AH, Owens PL, Stocks C, Patrick SW. Neonatal abstinence syndrome and maternal opioid-related diagnoses: analysis of ICD-10-CM transition, 2013-2017. Hosp Pediatr. 2021;11:902–8. https://doi.org/10.1542/hpeds.2021-005845.

    Article  PubMed  Google Scholar 

  4. Ryan KS, Prewitt KC, Hayer S, Hedges MA, Benson AE, Lo JO. Opioid use in pregnancy: a review. Obstet Gynecol Surv. 2023;78:35–49. https://doi.org/10.1097/OGX.0000000000001094.

    Article  PubMed  Google Scholar 

  5. Ahmad F, Rossen L, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics; Hyattsville, Maryland, USA; 2021. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.

  6. Gabrielson SMB, Carwile JL, O’Connor AB, Ahrens KA. Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009–2018. Public Health. 2020;181:171–9. https://doi.org/10.1016/j.puhe.2019.12.014.

    Article  CAS  PubMed  Google Scholar 

  7. Bauer EC, Ahrens K, Carwile JL. Trends in diagnoses of neonatal abstinence syndrome at newborn hospitalization in Maine, 2009-2018. J Maine Med Cent. 2021;3. https://doi.org/10.46804/2641-2225.1071.

  8. US Census Bureau Public Information. Growth in urban population outpaces rest of nation. U.S. Census Bureau; Suitland, Maryland, USA; 2010. https://www.census.gov/newsroom/releases/archives/2010_census/cb12-50.html.

  9. Maine Health Data Organization. Hospital inpatient and outpatient data. 2023. https://mhdo.maine.gov/inpatient_outpatient.html.

  10. Dudley J, McGuire C, Kumarage A, Anumaka C, Ahrens K. Accuracy of the drug-dependency checkbox on the Maine birth certificate for Medicaid-covered births, 2016-2020. J Maine Med Cent. 2023;5. https://doi.org/10.46804/2641-2225.1139.

  11. Medicaid and CHIP Payment and Access Commission. Chapter 6: substance use disorder and maternal and infant health. Washington, D.C., USA; 2020. https://www.macpac.gov/publication/chapter-6-substance-use-disorder-and-maternal-and-infant-health/.

  12. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP) Fast Stats. 2023. https://datatools.ahrq.gov/hcup-fast-stats/.

  13. Maine Center for Disease Control and Prevention. Neonatal abstinence syndrome and prenatal opioid use diagnoses in Maine, 2016–2020. 2022.

  14. Ahrens KA, McBride CA, O’Connor A, Meyer MC. Medication for addiction treatment and postpartum health care utilization among pregnant persons with opioid use disorder. J Addict Med. 2021;16:56–64. https://doi.org/10.1097/ADM.0000000000000827.

    Article  Google Scholar 

  15. Jones R, Philbin J, Kirstein M, Nash E, Lufkin K. Long-term decline in US abortions reverses, showing rising need for abortion as Supreme Court is poised to overturn Roe v. Wade. Guttmacher Institute. 2022. https://doi.org/10.1363/2022.33582.

  16. Gelsinger C, Palmsten K, Lipkind HS, Pfeiffer M, Ackerman-Banks C, Hutcheon JA, et al. Provision of postpartum contraception before and after the start of the COVID-19 pandemic in Maine. Public Health Rep. 2023;138:655–63. https://doi.org/10.1177/00333549231170198.

    Article  PubMed  PubMed Central  Google Scholar 

  17. The American College of Obstetricians and Gynecologists. Medicaid reimbursement for postpartum LARC. 2022. https://www.acog.org/programs/long-acting-reversible-contraception-larc/activities-initiatives/medicaid-reimbursement-for-postpartum-larc.

  18. Lien J, Hayes T, Liu-Smith F, Rana D. Comparing maternal substance use and perinatal outcomes before and during the COVID-19 pandemic. J Perinatol. 2023:1–6. https://doi.org/10.1038/s41372-023-01613-8.

  19. Sorg MH, Soucier DS, Leidenfrost A. Maine monthly overdose report for January 2023. Margaret Chase Smith Policy Center, University of Maine; 2023. https://mainedrugdata.org/wp-content/uploads/2023/02/2023-01-ME_Monthly_OD_Report-final.pdf.

  20. Maine Center for Disease Control and Prevention, Maine Department of Health and Human Services. Maine maternal, fetal and infant mortality review panel annual report. 2021. https://www.maine.gov/dhhs/mecdc/population-health/mch/perinatal/documents/2021%20Annual%20Report.pdf.

  21. Grossman MR, Lipshaw MJ, Osborn RR, Berkwitt AK. A novel approach to assessing infants with neonatal abstinence syndrome. Hosp Pediatr. 2018;8:1–6. https://doi.org/10.1542/hpeds.2017-0128.

    Article  PubMed  Google Scholar 

  22. Maine Department of Health and Human Services. Maine opioid response strategic action plan. 2019. https://www.maine.gov/future/sites/maine.gov.future/files/inline-files/MaineOpioidResponse.StrategicActionPlan.FINAL_.12.11.19.pdf.

  23. Swann WL, Schreiber TL, Kim SY, McNeely H, Hong JH. Perceived impact of COVID-19 on prevention, treatment, harm reduction, and recovery services for opioid use disorder: national survey of local health departments. Subst Abus. 2022;43:993–8. https://doi.org/10.1080/08897077.2022.2060429.

    Article  CAS  PubMed  Google Scholar 

  24. Javaid S, Barringer S, Compton SD, Kaselitz E, Muzik M, Moyer CA. The impact of COVID-19 on prenatal care in the United States: qualitative analysis from a survey of 2519 pregnant women. Midwifery. 2021;98:102991. https://doi.org/10.1016/j.midw.2021.102991.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Maine Department of Health and Human Services. MaineMOM. Maine.gov. 2021. http://www.maine.gov/dhhs/oms/about-us/projects-initiatives/mainemom.

  26. Krans EE, Kim JY, Chen Q, et al. Outcomes associated with the use of medications for opioid use disorder during pregnancy. Addiction. 2021;116:3504–14. https://doi.org/10.1111/add.15582.

    Article  PubMed  PubMed Central  Google Scholar 

  27. U.S. Centers for Disease Control and Prevention. Treatment for opioid use disorder before, during, and after pregnancy. 2022. https://www.cdc.gov/pregnancy/opioids/treatment.html.

  28. Klaman SL, Isaacs K, Leopold A, et al. Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: literature review to support national guidance. J Addict Med. 2017;11:178–90. https://doi.org/10.1097/ADM.0000000000000308.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Devlin LA, Hu Z, Ounpraseuth S, et al. The influence of mediators on the relationship between antenatal opioid agonist exposure and the severity of neonatal opioid withdrawal syndrome. Matern Child Health J. 2023;27:1030–42. https://doi.org/10.1007/s10995-022-03521-3.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Maine Health Data Organization. Claims—the All Payer Claims Database (APCD). 2013. https://mhdo.maine.gov/claims.htm.

  31. Ahrens K, Burgess A, Milkowski C, Jonk Y, Munk L, Ziller E. Maine: a health-focused landscape analysis. University of Southern Maine, Maine Rural Health Research Center; 2022. https://digitalcommons.usm.maine.edu/cgi/viewcontent.cgi?article=1025&context=population_health.

Download references

Acknowledgements

We thank the following employees of the Maine Department of Health and Human Services for their support on this project and providing feedback that greatly improved the manuscript: Kim Haggan, Director of Data, Research, and Vital Statistics; David Jorgenson, Director of Data Analytics, Office of MaineCare Services; Olivia Alford, Director, Delivery System Reform, Office of MaineCare Services; and Michelle Probert, Medicaid Director, Office of MaineCare Services. Additionally, many thanks to Jenny Carwile, Associate Director at Sanofi, for her insightful comments on our manuscript. We are also immensely grateful to Erika Lichter and Fleur Hopper, of the Maine Center for Disease Control, for sharing their SAS code to import the birth certificate text files. We thank the Maine Health Data Organization, which is the data source for Hospital Inpatient Encounter Data. We used the Maine Health Data Organization’s Hospital Inpatient Encounter Data as authorized under Data Request Number 2021080901.

Funding

This project was supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award with 100 percent funding by CMS/HHS. The opinions expressed herein are the authors’ own and do not reflect the views of the Centers for Medicare & Medicaid Services, the United States Department of Health and Human Services, or the United States government. Results presented may or may not align with findings from the federal program evaluation.

Author information

Authors and Affiliations

  1. Muskie School of Public Service, University of Southern Maine, Portland, ME, USA

    Julia Dudley & Katherine A. Ahrens

  2. Department of Pediatrics, The Barbara Bush Children’s Hospital at Maine Medical Center, Portland, ME, USA

    Sarah M. B. Gabrielson

  3. Perinatal Addiction Medicine, Maine Medical Center, Portland, ME, USA

    Alane B. O’Connor

Authors
  1. Julia Dudley
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah M. B. Gabrielson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alane B. O’Connor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katherine A. Ahrens
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JD and KAA carried out all analyses of the data and together did most of the manuscript writing. SMBG and ABO helped to conceptualize and design this study, provided clinical expertise for interpretation of findings, and reviewed and revised the manuscript.

Corresponding authors

Correspondence to Julia Dudley or Katherine A. Ahrens.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dudley, J., Gabrielson, S.M.B., O’Connor, A.B. et al. Trends in maternal opioid use disorder and neonatal abstinence syndrome in Maine, 2016–2022. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01882-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41372-024-01882-x

Search

Advanced search

Quick links