Association of Polysubstance Exposure and Neonatal Weight Loss Among Infants Exposed to Opioids.

OBJECTIVE

To characterize the weight trajectories of infants exposed to opioids and evaluate the association between different exposures and risk of excessive neonatal weight loss.

STUDY

DESIGN

Using mother-baby linked electronic health records, vital records, and claims data, we identified a retrospective cohort of infants exposed to opioids born at a large, academic medical center (2010-2021). We characterized prenatal substance exposures 90 to 2 days before delivery, including medications for opioid use disorder (MOUD), non-MOUD opioids, selective serotonin reuptake inhibitors, benzodiazepines, gabapentin, cigarette smoking, and toxicology evidence of opioids and nonopioid exposures (eg, barbiturates, cannabinoids, amphetamines, cocaine). We parameterized neonatal weight loss as the maximum percentage decrease from birth weight in the first 14 days of life during birth hospitalization. We used multivariable linear regression to compare the association between prenatal exposures and maximum percentage weight loss.

RESULTS

Among 868 maternal-infant dyads exposed to opioids that were identified, 622 (71.7%) had prenatal exposure to at least 1 additional substance. Infants with additional prenatal exposures had a greater median weight loss and a later nadir in weight loss compared with those without additional exposures (P < .001). In analyses examining individual substances, MOUD prescriptions (coefficient 0.99; 95% CI 0.50-1.48) and positive toxicology for nonopioid drugs (coefficient 0.53; 95% CI 0.08-0.98) were associated with a greater maximum percentage weight loss.

CONCLUSIONS

Exposure to MOUD and nonopioid exposures were associated with greater weight loss among infants exposed to opioids during the first 14 days of life. These findings inform the clinical management of infants exposed to opioids to mitigate weight loss during the neonatal hospitalization.