Contact PD/PI: Wen, Xuerong ABSTRACT Opioid use among pregnant women has increased in recent years. Previous studies have suggested a significant association between maternal opioid use and many congenital malformations. However, research gaps remain on effects of maternal opioid use on mother pregnancy complications and children long-term developmental outcomes, and optimizing medication assisted treatment (MAT) for pregnant women with opioid use disorder (OUD). The limited data sources restrain our knowledge and creates a formidable research opportunity. In this project, we will investigate effects of maternal opioid use on multiple short- and long-term adverse pregnancy outcomes for mothers and infants. Two linked datasets will be used to examine different outcomes, provide a large sample size if outcome is rare, and validate the estimation of pregnancy window. Our preliminary data has shown that prescription opioid use has increased in pregnant women enrolled in RI Medicaid. It is very necessary to comprehensively evaluate the safety of opioids on both mother and infant. The focus of this project is to study the relationship between perinatal opioid exposure and adverse health outcomes in mothers and children. We hypothesize that prescription opioid use during pregnancy increases pregnancy complications for mothers and poses long term developmental risks for children, and that MAT with methadone or buprenorphine in pregnant women with OUD improves health outcomes for both mothers and children. Specific Aim 1 will examine the association between perinatal exposure to prescription opioids and adverse outcomes in mothers and children. First, we will characterize the pattern of prescription opioid use in pregnant women. We will next test whether perinatal exposure to prescription opioids is associated with increased risk of pregnancy complications in mothers and birth defects in children, and reduced long-term neurodevelopment and educational status in children. Specific Aim 2 will examine the association between perinatal exposure to MAT and adverse outcomes in mothers and children. The pattern of Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) use in pregnant women with OUD will be characterized and compared. We will further determine whether there are significantly different effects for MMT versus BMT on all these adverse pregnancy outcomes for mothers and children. Outcome: This work will significantly impact the field of opioid safety in pregnancy by demonstrating: 1) Maternal exposure to prescription opioids during pregnancy increases pregnancy and obstetric complications, 2) Perinatal exposure to prescription opioids increases birth defects in infants, 3) Perinatal exposure to prescription opioids reduced long term neurodevelopment and educational status in children, 4) Identity optimal MMT with less adverse short- and long-term health outcomes for mothers and children. AREA impact: This project will provide an excellent intellectual and technical training environment for undergraduates and enhance the research capacity at the University of Rhode Island. Project Summary/Abstract

NARRATIVE The rapid increase in the incidence of opioid-related overdoses and deaths has become a major public health threat in the United States. Understanding how opioid exposure during pregnancy impacts mother and infant health will improve drug safety and help us to better control opioid use during pregnancy. Our results will help determine the role of perinatal opioid exposures on children development and provide evidences for improved perinatal care.