33 - Effects of Social and Environmental Factors on Growth in Opioid-Exposed Infants

Publication Number: 2030.33

Nika Renshaw, Tufts University School of Medicine, Hanover, NH, United States; Marissa Chow, Floating Hospital for Children at Tufts Medical Center, Boston, MA, United States; Kiran Singh, Tufts Medical Center, Boston, MA, United States; Nandita Meharwal, Tufts University School of Arts and Science, Wayland, MA, United States; Devika Lekshmi, Tufts University School of Medicine, Boston, MA, United States; Elizabeth Yen, Tufts Medicine Pediatrics-Boston Children's, Boston, MA, United States

Background: In-utero opioid exposure is a known risk factor for smaller size at birth. It is unclear whether social and environmental factors contribute to the growth disparity in the opioid-exposed infants.

Objective: To determine the effects of maternal social and environmental (Soc-Env)  factors  on  growth measurements in opioid-exposed and non-exposed infants.

Design/Methods: In this prospective observational study, mothers with and without opioid use disorder (OUD) were enrolled to fill out three surveys to assess the Soc-Env factors: 1) THRIVE: access to housing, food, medicine, transportation, heating/electricity, childcare, employment, and education, 2) Kotelchuck Index: adequacy of prenatal care (initiation and receipt of services), and  3) Socioeconomic status (SES) screening: employment, annual income, and level of education.  Maternal and demographic data included race/ethnicity, delivery method, cigarette use, insurance type (private vs. public), group B streptococcus (GBS) status, Apgar at 1 and 5 minutes,  gestational age, sex, length of stay, and anthropometric measurements (birth weight/BW, head circumference/HC, length/L, and corresponding percentiles). For mothers with OUD, we also recorded the types of opioids and polysubstance use. Continuous data were analyzed using the student’s t-test, categorical data using chi squared test. Multivariate regression was performed for Soc-Env factors and infant anthropometric measurements. Significance was set at p< 0.05.

Results: Nine mothers with OUD and 19 without OUD were enrolled.  Demographic data showed a significantly higher proportion of cigarette use and longer hospital stay in the  OUD cohort (Table 1). The OUD cohort also had significantly lower education levels, greater use of food supplemental programs, higher unemployment rate, and inadequate prenatal care (Table 2). Multivariate regression analyses showed that the THRIVE, Kotelchuck Index, SES, and composite scores were negatively associated with anthropometric measurements, but significance was only noted for L% (with the composite scores [t=-2.32, 95% CI -4.19 to -0.25] and with the SES scores [t=-2.32, 95% CI -7.30 to -0.42]).

Conclusion(s): Soc-Env factors may contribute to growth stunt in opioid-exposed infants. Non- significant associations between the categorical and composite Soc-Env scores with weight and head size measurements may be due to the small sample size. Future studies will enroll a larger sample size and examine maternal and infant characteristics that may modify and improve growth in opioid-exposed infants.

Table 1. Demographic Data
DemoTable1_Renshaw.pdfBW=birth weight, HC=head circumference, L=length, NSVD=normal spontaneous vaginal delivery, GBS=group B streptococcus, NAS=neonatal abstinence syndrome. Data are presented as mean ± standard deviation or median (interquartile ranges) for continuous measures, and N (%) for categorical measures. Bold indicates significance.

Table 2. Social and Environmental Data
DemoTable2_Renshaw.pdfWIC=Women, Infants, & Children Nutrition Program, SNAP=Supplemental Nutrition Assistance Program. Data are presented as N (%). Bold indicates significance.