ADDRESSING NEONATAL ABSTINENCE SYNDROME IN RURAL COMMUNITIES

ADDRESSING NEONATAL ABSTINENCE
  SYNDROME IN RURAL COMMUNITIES
  2021 RCORP-NAS Annual Meeting

WANDA D. BARFIELD
MD, MPH, FAAP, RADM USPHS (RET.)
DIRECTOR, CDC DIVISION OF REPRODUCTIVE HEALTH
Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

Division of Reproductive Health

Disclosures
I, Dr. Wanda Barfield, have no relationships with any commercial interests that would
represent a conflict of interest with the educational presentation that follows.

The findings and conclusions in this report are those of the authors and do not
necessarily represent the official position of the Centers for Disease Control and
Prevention.

MATERNAL AND INFANT HEALTH IN RURAL AREAS

DISPARITIES BETWEEN RURAL AND URBAN AREAS
                                      Pregnancy-Related Mortality Ratios by Urban-Rural Category

Merkt PT, Kramer MR, Goodman DA, Brantley MD, Barrera CM, Eckhaus L, Petersen EE. Urban-rural differences in pregnancy-related deaths, United States, 2011-2016. Am J Obstet
Gynecol. 2021 Feb 25:S0002-9378(21)00144-7. doi: 10.1016/j.ajog.2021.02.028. Epub ahead of print. PMID: 33640361.

INFANT MORTALITY: RURAL AND URBAN AREAS IN THE U.S.
               Infant mortality rates, by urbanization level: United States, 2014

          SOURCE: NCHS, National Vital Statistics System.

CDC LOCATe®
• Created based on need identified by
    states working in risk-appropriate care, in
    partnership with ACOG/SMFM and AAP
• Completed on web-based platforms                                                                                            Implemented
                                                                                                                              (24)
• Produces standardized maternal and
    neonatal level of care assessments for
    birth facilities
• Aligns with guidelines1,2,3 published by
    ACOG/SMFM and AAP

1 AAP Committeeon Fetus and Newborn (2012). "Levels of Neonatal Care." Pediatrics 130(3): 587-597.
2 ACOG/SMFM  (2019). "Levels of Maternal Care." Obstetrics & Gynecology 134(2):e41-55.
3AAP Committee on Fetus and Newborn and ACOG Committee on Obstetric Practice (2017). Guidelines for Perinatal Care, 8th Ed.

OPIOID WITHDRAWAL SYNDROME IN NEWBORNS

NEONATAL
ABSTINENCE
SYNDROME AND
MATERNAL OPIOID-
RELATED DIAGNOSES
RATES PER 1,000,
2010-2017

Source: Hirai AH, Ko JY, Owens PL, Stocks C,
Patrick SW. Neonatal Abstinence Syndrome
and Maternal Opioid-Related Diagnoses in
the US, 2010-2017. JAMA.
2021;325(2):146–155.
doi:10.1001/jama.2020.24991

Neonatal Abstinence Syndrome

STATE-LEVEL
VARIATION IN
NEONATAL
ABSTINENCE
SYNDROME AND
MATERNAL OPIOID-                                       Maternal Opioid-Related Diagnoses
RELATED DIAGNOSES
RATES IN THE US,
2010-2017
Source: Hirai AH, Ko JY, Owens PL, Stocks C, Patrick
SW. Neonatal Abstinence Syndrome and Maternal
Opioid-Related Diagnoses in the US, 2010-2017.
JAMA. 2021;325(2):146–155.
doi:10.1001/jama.2020.24991

Disparities in Treatment of OUD

There are also racial and ethnic disparities in the use of
medications for the treatment of opioid use disorder1
• Black and Hispanic women with OUD were significantly less
    likely to use any medication for treatment and were less likely
    to consistently use medication for treatment during pregnancy
    compared with White women with OUD
1Schiff DM, Nielsen T, Hoeppner BB, et al. Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in
Massachusetts. JAMA Netw Open. 2020;3(5):e205734. doi:10.1001/jamanetworkopen.2020.5734

CDC STRATEGIES TO ADDRESS OPIOID USE DISORDER AMONG
PREGNANT AND POSTPARTUM WOMEN AND INFANTS

Supporting Efforts to Prevent
Maternal Opioid Misuse and Harm

       Conduct Surveillance and Research
         • Pregnancy Risk Assessment Monitoring System (PRAMS)
         • Rapid Maternal Overdose Review (RMOR)

       Build State, Local, and Tribal Capacity
         • Opioid use disorder, maternal outcomes and neonatal abstinence
           syndrome initiative (OMNI)

       Support Providers, Health Systems, and Payers
         • Perinatal Quality Collaboratives (PQC)
         • AAP Maternal-Infant Health and Opioid Use project

PRAMS
• Identify sociodemographic and
                                            Two Components
  behavioral risks associated with opioid   Opioid Supplement
  use and misuse around the time of         • 32 states received funding to add a
  pregnancy                                   set of supplemental questions on
                                              opioid use and misuse to their
                                              PRAMS survey
                                            Call-Back Survey
                                              • 7 states with a high rate of opioid-
                                                related overdose deaths
                                              • Call‐back survey of previously
                                                interviewed mothers at 9 months
                                                postpartum

Opioid Use Disorder, Maternal Outcomes, and Neonatal
Abstinence Syndrome Initiative (OMNI)
Goal: Support states in efforts to implement system changes to improve
identification and treatment of pregnant and postpartum women with
OUD and infants with NAS
 Supports to build capacity
    Action planning meetings
    Virtual learning sessions
    Consultations with SMEs in the field
    Peer-to-peer conference calls
    Tools and resources
    Short-term technical assistance
    Long-term field placements in 5 states

State-Based PQCs – Opioid Specific Activities

                                                PQC that receive
                                                CDC funding for
                                                opioid-specific
                                                activities

PQC State Examples
• Illinois Perinatal Quality Collaborative (ILPQC)
  •   Implemented system changes such as screening, treatment algorithms, checklists and local resource mapping
      at all 107 birthing hospitals.
  •   By March 2020, the Labor & Delivery units of all ILPQC hospitals had a validated screening tool
      •   81% have a Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol/algorithm,
      •   93% have mapped community resources for women with OUD.

• Colorado Perinatal Care Quality Collaborative (CPCQC)
  •   Connects rural and frontier hospitals to community and statewide resources
      •   Supported the virtual "Rural Maternal Behavioral Health Open House“
      •   Connected hospitals with state-funded Peer Recovery Navigators and the
          Regional Health Connectors

AAP MATERNAL-
INFANT HEALTH
AND OPIOID USE
PROJECT

www.aap.org/NOWS

THANK YOU.

QUESTIONS?

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion

                              Division of Reproductive Health

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.