Neonatal Infectious Harm Reduction Benefits of Maternal Substance Use Treatment: A Dyad-Based Retrospective Review

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Abstract Background Substance use disorders (SUD) in pregnancy can disrupt routine prenatal care and have been linked to increased risk of congenital syphilis as well as perinatal exposure to hepatitis C (HCV) and human immunodeficiency virus (HIV). Moreover, inconsistent adherence to universal HCV maternal screening recommendations, fragmented care, and frequent removal of infants for child welfare often make timely identification of maternal HCV or syphilis infection challenging and follow-up screening of exposed infants difficult to ensure. Although SUD treatment—and particularly medications for opioid use disorder (MOUD)—has been shown to reduce the risk of HIV and HCV acquisition in non-pregnant individuals, its infectious harm reduction potential in pregnancy for both mother and infant has seldom been explored. Methods 60 mother-infant dyads enrolled between 2018-2022 were randomly selected from an institutional obstetric substance use treatment program database. All were enrolled before 32 weeks gestation and had active substance use. Records were manually reviewed for completion of American College of Obstetrics and Gynecology (ACOG) and Centers for Disease Control and Prevention (CDC) recommended screenings for sexually-transmitted infections (STIs), congenital syphilis exposures and outcomes, HIV and HCV perinatal exposures, and post-discharge referrals for maternal and infant HCV screening and treatment. Results 51 of 60 dyads followed through until delivery of a viable infant. Maternal entry to program screening rates were >95% for gonorrhea, chlamydia, syphilis, and HIV and >90% for HCV. Over half of mothers received MOUD and reported prior history of injection drug use. 88% were re-screened for syphilis in the 3rd trimester and 91% were screened for syphilis at delivery. One case of primary syphilis in pregnancy was diagnosed in the 3rd trimester and one case of congenital syphilis was diagnosed. 22 (39%) of mothers were HCV-antibody positive, with 16 found to have detectable HCV RNA. Five new diagnoses of HCV were made upon care entry. Postpartum HCV treatment referrals were made for 88% of mothers, and 79% of HCV-exposed infants had appropriate post-discharge screening recommendations documented. Conclusion Pregnant patients enrolled in a dedicated obstetric addiction treatment program had higher rates of guideline recommended syphilis and HCV screening than reported in national and regional Medicaid cohorts. Participation also facilitated identification of exposed infants and referral for maternal HCV treatment post-partum. Larger matched cohorts are needed to better compare the incidence of congenital syphilis, perinatal HIV, and HCV in this population, as well as assess the effects of maternal MOUD on vertical transmission risk.