Examining mortality in infants with prenatal opioid exposure

April 15, 2021
Miranda Hester

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

A study offers much needed information on the rate of infant mortality in infants who have prenatal exposure to opioids.

With the continuing opioid epidemic, it’s increasingly necessary to understand the impact that exposure to opioids has on infants, as knowledge on the subject thus far has been sparse. A report in JAMA Pediatrics offers much needed information.1

Investigators conducted a retrospective cohort study of mother-infant pairs that linked health care claims to vital records for births between January 2010 to December 2014. A pair was included in the study if the infant was born in Texas at 22 to 43 weeks’ gestational age and the mother was aged 15 to 44 years and was insured by Texas’s Medicaid program. Primary exposure was prenatal exposure to opioids and infants were stratified by the presence or absence of a diagnosis of neonatal opioid withdrawal syndrome during the hospitalization at birth.

A total of 1,129,032, mother-infant pairs were included in the study. There were 7207 pairs who had prenatal opioid exposure of which 4238 had a neonatal opioid withdrawal syndrome diagnosis (mean birth weight, 2851 [624] g) and 2969 who didn’t have a diagnosis (mean birth weight, 2971 [639] g). The infant mortality was 6 per 1000 live births in the reference group, 11 per 1000 live births for infants with neonatal opioid withdrawal syndrome, and 20 per 1000 live births for infants exposed to opioids who were not diagnosed with neonatal opioid withdrawal syndrome (P < .001). After adjusting for neonatal and maternal characteristics, the mortality in infants with a neonatal opioid withdrawal syndrome diagnosis didn’t significantly differ from the reference population (odds ratio, 0.82; 95% CI, 0.58-1.14), whereas the mortality odds in opioid-exposed infant who didn’t have a neonatal opioid withdrawal syndrome diagnosis was 72% greater than the reference population (odds ratio, 1.72; 95% CI, 1.25-2.37).

The investigators concluded that infants exposed to opioids were at increased risk of mortality and the treatment and other supports given to infants with neonatal opioid withdrawal syndrome could be protective. They concluded interventions are necessary, regardless of the severity of the withdrawal from opioids in the infant.


1. Leyenaar J, Schaefer A, Wasserman J, Moen E, O'Malley J, Goodman D. Infant mortality associated with prenatal opioid exposure. JAMA Pediatr. April 12, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.6364