The Mother & Baby Substance Exposure Initiative was active from January 2019-September 2020. 

Why we care about this topic

Neonates who have been exposed to substances in utero, both prescribed and non-prescribed, are at risk for health problems at birth. With opioid use during pregnancy on the rise, infants are at an increased risk of in utero exposure and of developing withdrawal symptoms at birth, a condition known as neonatal abstinence syndrome (NAS). Between 1999 and 2013, NAS incidence increased 300% from 1.5/1,000 hospital births to 6.0/1,000 hospital births. By 2012, one infant was born every 25 minutes, on average, experiencing signs of withdrawal. Infants who are also exposed to other illicit drugs, alcohol, nicotine, and selective serotonin reuptake inhibitors (SSRIs) are at increased risk of developing NAS.

Our approach

The Mother & Baby Substance Exposure Initiative, part of the Medication Assisted Treatment Expansion Project, is a hospital and community-based effort to improve outcomes for mothers and newborns impacted by substance exposure, with a specific focus on Opioid Use Disorder. The Mother & Baby Substance Exposure Initiative emphasizes care that maintains the mother/baby dyad throughout the hospital stay and will also address treatment and prevention of substance exposure during and after pregnancy. 

CPQCC and CMQCC  are jointly implementing this project in collaboration with Health Management Associates (HMA). The Mother & Baby Substance Exposure Initiative is funded by the California Department of Health Care Services (DHCS) as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid Response grant. 
Key components of this initiative include:

  • Leading a multidisciplinary taskforce of experts from across California to develop a toolkit for maternal and newborn care providers on perinatal substance exposure, with a focus on opioid exposure
  • Implementing quality improvement collaboratives for hospitals in selected counties across Northern, Central and Southern California
  • Collecting and reporting data to support quality improvement
  • Mobilizing and supporting public and private partners across the state
  • Networking and learning from other states that have implemented the Alliance for Innovation on Maternal Health (AIM) National Collaborative Opioid Bundle 

The Toolkit

The Mother & Baby Substance Exposure Initiative Toolkit was developed by a multidisciplinary taskforce of maternal and newborn health care experts to improve outcomes for substance-exposed mothers and newborns.

The interactive online toolkit shares best practices across the care continuum for:

  • Screening Assessment and Level of Care Determination
  • Treatment
  • Transition of Care
  • Education

Best practices are organized both by topic area and the type of practice setting: outpatient, labor and delivery and nursery-NICU. Key themes of the toolkit include:

  • Every pregnant woman should be screened
  • Every pregnant woman with opioid use disorder (OUD) should be on Medication Assisted Treatment (MAT)
  • Providers should encourage non-pharmacologic treatment for neonatal abstinence syndrome (NAS) where appropriate based on increasing evidence demonstrating its superiority
  • Moms and babies should receive support to keep them together