(1106) Role of prenatal care in modifying the risk of NAS among mothers with OUD

Objective: To examine the risk of neonatal abstinence syndrome (NAS) among mothers with opioid use disorder with low and high engagement with prenatal care.

Study Design: We conducted a retrospective cohort study of births in the state of California from 2008-2020 among individuals with opioid use disorder to compare rates of NAS between those with < 5 prenatal visits and ≥5 prenatal visits. NOWs rates were assessed in the overall cohort then stratified by urban/rural residence. We performed multivariable logistic regression controlling for age, race/ethnicity, education, pre-pregnancy BMI, parity, and insurance status to estimate adjusted odds ratios (aOR) and 95% confidence intervals.

Results: In the cohort of 10,654 individuals with opioid use disorder, 2,147 (20.15%) attended < 5 prenatal visits and 8,507 (79.85%) attended ≥5 prenatal visits. There was lower prenatal care attendance among individuals aged 20-34, those with public insurance, and those with high school education or less. In the overall cohort, the adjusted odds of NAS was significantly higher among individuals with < 5 prenatal visits (aOR=1.29; 95% CI 1.15-1.44). Similar significant results were found in rural residents; however, the results were not statistically significant in urban residents.

Conclusion: Our study found that among pregnant individuals with opioid use disorder, those with lower prenatal care had a higher risk of NAS in the infant. Close follow up of pregnant individuals with opioid use disorder through prenatal visits may reduce the burden of NAS among neonates.