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CME Credit Offered
CME Credit Offered
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Poster Session 4

(987) Fentanyl exposure in the era of xylazine: an update on perinatal outcomes

Friday, January 31, 2025
4:00 PM – 6:00 PM  
Objective: Xylazine, a non-opioid veterinary sedative, is increasingly contaminating nonprescribed fentanyl. We sought to explore outcomes in fentanyl-exposed obstetric patients in an urban labor unit with high prevalence of xylazine in the local fentanyl supply.

Study Design: We performed a retrospective cohort study of all pregnant patients with nonprescribed fentanyl on urine drug screening (UDS) at a Midwestern tertiary care center in 2023. UDS via mass spectrometry is performed after a positive result on universal verbal screening. The primary outcome was preterm birth (PTB). Secondary outcomes included out of hospital birth (OOHB), adult intensive care unit (ICU) admission, neonatal ICU (NICU) admission, and other perinatal metrics. A secondary analysis comparing xylazine positive and negative dyads was performed with Χ2 or Mann Whitney U tests as appropriate.

Results: 65 patients were identified. 57 had peripartum care in our facility, and 56 had neonatal data available with 59 neonates after accounting for twins. 62% of pregnant patients had xylazine exposure. Groups were similar aside from higher rates of intravenous drug use in the xylazine group (41.5 vs 16.7%, p= 0.04). 41.7% of xylazine exposed patients experienced PTB, compared to 28.6% of unexposed patients (RR 1.46, 95% CI 0.67-3.18) with a median gestational age of 37 weeks. Unplanned OOHB occurred in 19.4% of xylazine positive dyads and 9.5% of negative dyads, maternal ICU admission in 5.9% and 16.7%, and NICU admission in 76.5% and 70%, though differences were not significant.  Xylazine dyads had lower rates of antepartum bleeding (2.4 vs 25%, RR=0.09, [0.01-0.76]) and higher fentanyl positivity at delivery (100 vs 81%, RR=1.23, [1.003-1.52]). Xylazine exposed neonates were less likely to be discharged in parental custody (5.6 vs 26.1%, RR 0.21, [0.58-2.3]).

Conclusion: Perinatal fentanyl use is associated with significant obstetric and neonatal morbidity regardless of xylazine exposure. Preliminary data suggests that xylazine may be a marker of severe disease and should be targeted for future study.