Disparities in Breastfeeding Outcomes Between Women Undergoing Medication‐Assisted Treatment (MAT) for Substance Use Disorder (SUD) and Abstaining Controls

Abstract

Opioid use and abuse is epidemic in the United States. MAT for SUD during pregnancy reduces the risk of adverse perinatal outcomes. Breastfeeding can reduce the severity of neonatal abstinence syndrome, and is recommended for patients in MAT programs who are negative for HIV and not actively using illicit drugs. Breastfeeding outcomes were compared among women undergoing MAT (n=30) and abstaining controls (CON; n=28) in a prospective ENRICH birth cohort in New Mexico (NM). The MAT group was further stratified into: MAT/no prenatal alcohol use (MAT‐noA; n=17) and MAT with prenatal alcohol use (MAT‐A; n=13). Patients were recruited during pregnancy and followed up to 6 months postpartum. Data were self‐reported through prospective structured maternal interviews and verified by a review of electronic medical records, urine drug tests and ethanol biomarkers. The associations between prenatal exposures and other covariates and lactation initiation and continued lactation at 6 months postpartum were examined using Fisher's exact test and logistic regression.All participants delivered in a Baby Friendly hospital. Overall, about two‐thirds of all participants were Hispanic, half were overweight or obese before pregnancy, one‐third had a C‐section delivery, and 12% had a preterm delivery, with no significant differences between groups. There were significant differences between MAT and CON groups, respectively, for planned pregnancy (17% vs. 61%; p=0.002); WIC utilization (97% vs. 46%; p<0.0001); Medicaid or no insurance (93% vs. 57%; p=0.002); breastfeeding initiation (77% vs. 100%; p=0.01); and breastfeeding at 6 mo (17% vs. 56%; p=0.005). In subgroup analyses, fewer MAT‐A participants (69%) initiated breastfeeding compared to MAT‐noA participants (82%); but more MAT‐A participants reported breastfeeding at 6 months (31%) than MAT‐noA participants (6%).After adjustment for C‐section, infant prematurity, SES and perceived stress index, the difference in breastfeeding initiation between the MAT and CON groups was slightly attenuated (OR not breastfeeding = 8.01; 95% CI: 0.79, 81.21; p=0.08). At 6 mo, differences persisted between the MAT and CON groups (OR not breastfeeding = 3.97; 95% CI: 1.04, 148; p=0.04) in the same multivariable model.In the NM general population, 85.5% of women initiate breastfeeding and 51.1% continue to 6 months (CDC Breastfeeding Report Card 2016). At a Baby Friendly hospital, there were consistent disparities in breastfeeding outcomes for women on MAT compared to controls and NM state averages, particularly at 6 mo. Additional research should be conducted to better understand these disparities and identify appropriate interventions.Support or Funding InformationFunded by NIH R01 AA021771