MORTALITY OF MOTHERS OF INFANTS BORN WITH NEONATAL ABSTINENCE SYNDROME: A POPULATION-BASED TWENTY YEAR COHORT STUDY
Bibliographic record
Abstract
BACKGROUND: With increasing rates of opioid use during pregnancy, the incidence of neonatal abstinence syndrome (NAS) is rising across North America. While perinatal outcomes for infants born with NAS have been well-described, little is known about long-term maternal health outcomes in this vulnerable population. OBJECTIVES: To describe all-cause mortality in mothers of infants born with NAS (NAS-mothers) and to compare their mortality rates and demographic characteristics to mothers of healthy infants (non-NAS mothers). DESIGN/METHODS: This population-based cohort study included mothers (aged 12 to 49 years) of 1,590,910 live births in Ontario, Canada (1994-2014) and used multiple health and demographic administrative databases. Infants born in hospital with and without NAS were identified through hospital birth records and linked to maternal healthcare and death certificate data. Poisson regression models estimated rate ratios of all cause mortality with 95% confidence intervals [CI’s]. RESULTS: 5130 NAS mothers and 1,585,780 non-NAS mothers were included with a median of 11.15 person years of follow-up. NAS mothers were younger (median age 27 years (IQR 23 – 32) vs. 30 (IQR 26 – 34), more often ≤19 years of age (6.3% vs. 3.9% in non-NAS mothers), and had a larger proportion of the population living in the lowest neighborhood income quintile (40.8% vs. 22.6%) and in rural areas (18.5% vs. 10.0%). Only half (46.8%) of NAS-mothers received addiction medicine services in the year prior to delivery of their infant. The mortality rate per 1000 follow-up years of NAS-mothers was 4.64 (95% CI 4.45, 4.85) compared to 0.58 (95% CI 0.58, 0.59) among non-NAS mothers. The unadjusted rate ratio for mortality in NAS vs non-NAS mothers was 7.96 (95% CI 7.62, 8.31). Accident or injury-related deaths accounted for 27.8% of deaths in NAS mothers and only 8.7% of non-NAS mothers whereas cancer-related deaths accounted for 6.6% and 35.5% deaths in these groups, respectively. CONCLUSION: The eight-fold higher mortality rate observed in mothers of infants with NAS is concerning. These findings suggest a pressing need to provide added support for women with chronic opioid use both during and after pregnancy. Further study of cause-specific mortality and other health outcomes including injury and mental health of this population is warranted.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".