Statement of Purpose Neonatal opioid withdrawal syndrome (NOWS) is an expected and treatable condition following prenatal exposure to opioids, including medication for opioid use disorder (MOUD), the recommended treatment for opioid use disorder (OUD) in pregnancy.

Methods/Approach To inform intervention and reduce stigma associated with NOWS, we used 2016–2018 North Carolina birth certificate and Medicaid claims data to estimate use of MOUD and other prescription opioids in pregnancy among mothers of infants with NOWS (N=3,395) and to compare maternal and infant characteristics by patterns of use.

Results Among mothers of infants with NOWS, 39% had claims for MOUD only, 14% had claims for prescription opioids only, 8% had both claims for MOUD and prescription opioids, and 39% did not have claims for either in pregnancy. Relative to other groups, the percent of younger women was higher among those with neither MOUD or prescription opioids (37% <25 years), and the percent of Black non-Hispanic women was higher among those with prescription opioids only (21%) and neither MOUD or prescription opioids (30%). The percent of infants born full term and normal birthweight was highest among women with MOUD (86% and 86%) or both MOUD and prescription opioids (82% and 80%). The percent of women with no prenatal care (10%) and the rate of infant mortality (3.5 deaths per 100,000 infant days) was highest among infants of women with neither MOUD or prescription opioids. Overall, 60% of mothers of infants with NOWS had MOUD or prescription opioid claims in pregnancy, underscoring the extent to which cases of NOWS may be related to medically directed opioid use in pregnancy.

Conclusion Results underscore the urgent need to prioritize efforts to improve equity in access to MOUD and promote provision of non-stigmatizing prenatal care among pregnant women engaging in opioid use or with OUD to ensure healthy maternal and infant outcomes.