Food insecurity in women with opioid disorders complicates child outcomes

Food insecurity and addiction usually are not looked at in tandem conceptually, but a newly published study demonstrates how food insecurity among pregnant women with opioid use disorders can worsen neonatal outcomes for their children.

Published in the journal Addiction, the study involving 75 women receiving opioid use disorder treatment at Boston Medical Center found a three- to four-fold increase in receipt of pharmacological treatment for neonatal abstinence syndrome (NAS) among infants of mothers who reported being food insecure. The women in the study were being treated in a Boston Medical Center integrated care program that offers both obstetric and opioid use disorder treatment.

The study also helps to demonstrate the ease with which professionals can screen patients for food insecurity, through a two-question instrument addressing stress over running out of food and not being able to buy more.

“I really, really wanted to make this apparent to addiction professionals,” study lead author Ruth Rose-Jacobs, ScD, tells Addiction Professional. “This is new news to them.”

Rose-Jacobs, an associate professor of pediatrics at the Boston University School of Medicine, suggests that the study helps to affirm the critical relationship between quality-of-life variables and outcomes related to substance use disorders.

“You have to have your basic needs met before you can reasonably deal with other bigger issues,” Rose-Jacobs says.

Details of study

The pregnant women selected for the study were in their third trimester and were receiving methadone or buprenorphine treatment. The researchers analyzed outcomes for infants born at 36 weeks or more gestational age, with no major medical complications. The primary outcomes that were examined were any pharmacological treatment for NAS and length of hospital stay due to NAS.

Women were interviewed in their third trimester and were asked about food insecurity in the past six months, through use of the validated two-question Hunger Vital Sign. This instrument takes the first two questions of a much lengthier U.S. Department of Agriculture questionnaire. It asks whether there was worry over food running out before money was available to buy more, and whether the food that was purchased indeed didn't last and there was no money to buy more. An affirmative response to either question denotes food insecurity.

A total of 57% of the women in the study reported food insecurity—a percentage considerably greater than that seen in the larger group of mothers with low-income backgrounds treated at Boston Medical Center. After controlling for factors such as prenatal maternal depression, the researchers found that women reporting food insecurity were more likely to have infants who needed pharmacological treatment for NAS. No association was found between food insecurity and infants' length of hospital stay.

“Food insecurity is often not obvious in U.S. women of childbearing ages, as it is not systematically related to maternal weight or weight gain,” study authors wrote. This suggests why it is important for professionals to have access to simple and validated screening tools for food insecurity, Rose-Jacobs says.

The mechanisms that may be at work in influencing NAS among the infants of these women include limited maternal nutrition and additional maternal stress that can be transmitted to the infant.

“If you don't have enough food and you're not properly housed, it's hard to focus your attention on addiction,” says Rose-Jacobs. “If there's not enough money to buy food, you buy cheap food, empty- but high-calorie foods.”

Clinicians have easy ways to ask patients about food insecurity, but then also must familiarize themselves with referral options in the community, such as federally supported aid programs and local food pantries, Rose-Jacobs says.