Association between Prenatal Adversity and Neonatal Outcomes in Infants with Prenatal Opioid Exposure

Abstract

ObjectiveExamine whether prenatal adversity is associated with Neonatal Opioid Withdrawal Syndrome (NOWS) severity and the need for pharmacological treatment in infants with prenatal opioid exposure.

Study DesignProspective cohort study of 235 infants from a multi-center study of infants with prenatal opioid exposure. Maternal factors were assessed using the electronic medical record and maternal questionnaires. Latent Class Analysis (LCA) was used to derive mutually exclusive prenatal adversity groups.

ResultsA 3-class LCA solution provided the best fit to the data and showed 3 distinct groups: one low adversity group (Class 3, 38.7%) and 2 high adversity groups. Infants born to mothers with elevated demographic, medical, polysubstance, and mental health risk factors (Class 1, 31.9%) were more likely to require pharmacological treatment for NOWS (OR=7.70, 95% CI: 3.65-17.14) and had higher NOWS severity, as indexed by longer length of stay ({beta} = 6.08, 95% CI: 4.09-8.07), and higher maximum Finnegan scores ({beta} = 2.62, 95% CI: 1.49-3.76). Infants born to mothers with elevated medical and polysubstance risk factors (Class 2, 29.4%) were also more likely to receive pharmacological treatment for NOWS (OR=3.22, 95% CI: 1.56-6.78) and had higher NOWS severity, as indexed by higher likelihood of receiving adjunctive medication (OR=3.62, 95% CI: 1.11-12.99).

ConclusionMaternal sociodemographic, mental health, substance use, and medical adversity may serve as an early marker of NOWS severity and may aid in the prediction of which neonates will require pharmacological treatment for NOWS. Early identification of infants at high risk for NOWS could lead to earlier treatment and the potential to reduce NOWS severity, length of stay, and associated healthcare costs.

Neonatal outcomes and immune reprogramming induced by prenatal opioid and hepatitis C exposure
Brianna M. Doratt, Heather E. True, Sheridan B. Wagner +4
Frontiers in Immunology13 Oct 2026Peer-reviewedCC BY 4.0Full textObstetrics, gynaecology & paediatricsCrossrefPMC
Prenatal extreme heat exposure and neonatal mortality in Bangladesh, 2015 to 2025: a national birth-history study
S. M. A. U. Hoque, M. K. Hasan, M. K. Islam +4
medRxiv23 Oct 2026PreprintAll rights reservedFull textEpidemiology & public healthmedRxiv
Congenital Chloride Diarrhea Presenting With Polyhydramnios and Preterm Labor at 26 Weeks of Gestation: Prenatal and Neonatal Management
Fatima El Mangoub, Abdelhamid Benlghazi, Bouhtouri Yassine +2
Cureus1 Oct 2026Peer-reviewedCC BYFull textObstetrics, gynaecology & paediatricsEurope PMCPMC
Prenatal Vitamin C Supplementation Mediates the Association between Prenatal Distress and Infant Negative Affect: A Prospective Cohort Study
Elizabeth K. Wood, Hailey E. Volk, Elizabeth K. Nousen +6
Developmental psychology2 Nov 2026Peer-reviewedCC BY-NC-NDFull textEpidemiology & public healthPMC
Effects of prenatal exposure to maternal cortisol and psychological stress on neonatal development: the GENEIDA mother-infant cohort (Andalusia, Spain).
Rafael A Caparros-Gonzalez, Desirée Romero-Molina, Beatriz González-Alzaga +6
BMC pregnancy and childbirth4 Aug 2026Peer-reviewedCC BY-NC-NDFull textEpidemiology & public healthEurope PMCPMC

Cite

BibTeX RIS

BibTeX

@misc{heil2026association,
  title = {{Association between Prenatal Adversity and Neonatal Outcomes in Infants with Prenatal Opioid Exposure}},
  author = {M. Ramirez Heil and M. Donahue and M. Camerota and L. Dansereau and A. Craft and E. Conradt and B. Lester},
  howpublished = {medRxiv},
  year = {2026},
  month = oct,
  doi = {10.64898/2026.10.08.26365058},
  url = {https://www.medrxiv.org/content/10.64898/2026.10.08.26365058v1},
  note = {CC BY},
}

RIS

TY  - UNPB
TI  - Association between Prenatal Adversity and Neonatal Outcomes in Infants with Prenatal Opioid Exposure
AU  - M. Ramirez Heil
AU  - M. Donahue
AU  - M. Camerota
AU  - L. Dansereau
AU  - A. Craft
AU  - E. Conradt
AU  - B. Lester
PY  - 2026
DA  - 2026/10/08
PB  - medRxiv
DO  - 10.64898/2026.10.08.26365058
UR  - https://www.medrxiv.org/content/10.64898/2026.10.08.26365058v1
AB  - ObjectiveExamine whether prenatal adversity is associated with Neonatal Opioid Withdrawal Syndrome (NOWS) severity and the need for pharmacological treatment in infants with prenatal opioid exposure.  Study DesignProspective cohort study of 235 infants from a multi-center study of infants with prenatal opioid exposure. Maternal factors were assessed using the electronic medical record and maternal questionnaires. Latent Class Analysis (LCA) was used to derive mutually exclusive prenatal adversity groups.  ResultsA 3-class LCA solution provided the best fit to the data and showed 3 distinct groups: one low adversity group (Class 3, 38.7%) and 2 high adversity groups. Infants born to mothers with elevated demographic, medical, polysubstance, and mental health risk factors (Class 1, 31.9%) were more likely to require pharmacological treatment for NOWS (OR=7.70, 95% CI: 3.65-17.14) and had higher NOWS severity, as indexed by longer length of stay ({beta} = 6.08, 95% CI: 4.09-8.07), and higher maximum Finnegan scores ({beta} = 2.62, 95% CI: 1.49-3.76). Infants born to mothers with elevated medical and polysubstance risk factors (Class 2, 29.4%) were also more likely to receive pharmacological treatment for NOWS (OR=3.22, 95% CI: 1.56-6.78) and had higher NOWS severity, as indexed by higher likelihood of receiving adjunctive medication (OR=3.62, 95% CI: 1.11-12.99).  ConclusionMaternal sociodemographic, mental health, substance use, and medical adversity may serve as an early marker of NOWS severity and may aid in the prediction of which neonates will require pharmacological treatment for NOWS. Early identification of infants at high risk for NOWS could lead to earlier treatment and the potential to reduce NOWS severity, length of stay, and associated healthcare costs.
ER  -

Abstract

Related

Cite