(8) Breastfeeding in Postpartum Patients with Opioid Use Disorder

Background & Introduction: It is well known that breastfeeding is important to both maternal and neonatal health, with numerous short term and long term benefits. However, in patients with opioid use disorder (OUD), breastfeeding rates are often variable due to co-morbidities, including mental health disorders and prescribed medication use. This study sought to determine which maternal and neonatal factors may be barriers to breastfeeding.

Methods: This was a retrospective cohort study of women who delivered at a single institution between 2017 and 2023 diagnosed with OUD. Exclusion criteria were women that were ineligible to breastfeed by ACOG guidelines. Women were divided according to method of infant feeding (breastfeeding vs. formula) at time of discharge from the hospital. Multiple variables in these groups were examined, including parity, NICU admission, mode of delivery, diagnosis of neonatal opioid withdrawal syndrome (NOWS), and maternal mental health disorders. These groups were compared using SPSS using the Chi Square test with statistical significance defined as p < 0.05.

Results: 316 patients with OUD were identified. Breastfeeding occurred in 43.9% of patients with OUD (140/316). Patients who were advanced maternal age (greater than 35 years old), had bipolar disorder, treated with quetiapine, or had a neonate affected with NOWS were all much less likely to breastfeed their infants (Table 1). On regression analysis, the odds ratio for breastfeeding was decreased in those who had infants diagnosed with NOWS (OR 0.56 95% CI 0.31-0.99, p=0.04). The other variables in the model (multiparity, NICU admission, positive maternal urine toxicology, quetiapine use, and mode of delivery) did not retain significance in prediction of breastfeeding.

Conclusion & Discussion: Maternal risk factors associated with a decreased breastfeeding rate include advanced maternal age, bipolar disorder, and treatment with quetiapine. Infant risk factors associated with decreased breast feeding rate include infants diagnosed with NOWS. Targeted interventions should be implemented to support and encourage breastfeeding in patients with OUD whose infants are diagnosed with NOWS.

References: Stephen, J. M., Shrestha, S., Yakes Jimenez, E., Williams, S. M., Ortega, A., Cano, S., Leeman, L., & Bakhireva, L. N. (2020). Disparities in breastfeeding outcomes among women with opioid use disorder. Acta paediatrica (Oslo, Norway: 1992), 109(5), 1064–1066. https://doi.org/10.1111/apa.15107

Bogen, D. L., & Whalen, B. L. (2019). Breastmilk feeding for mothers and infants with opioid exposure: What is best?. Seminars in fetal & neonatal medicine, 24(2), 95–104. https://doi.org/10.1016/j.siny.2019.01.001

Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., & Rollins, N. C. (2016). Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/s0140-6736(15)01024-7