MAT-LINK2: Expansion of MATernaL and Infant NetworK to Understand Outcomes Associated with Treatment for Opioid Use Disorder during Pregnancy

STATUS: Completed Project

BACKGROUND

This project builds on an existing PCORTF project funded to establish a maternal and infant network to examine practice patterns and outcomes associated with the treatment for Opioid Use Disorder (OUD) during pregnancy, called MAT-LINK. This network created a data platform and standard maternal and infant data elements to collect linked maternal and infant data among women treated for OUD during pregnancy in four clinical sites across the US: Boston Medical Center, Ohio State University, University of Utah, and Kaiser Foundation Research Institute Northwest in Oregon and Washington. 

To strengthen the robustness and representativeness of future findings, MAT-LINK 2 added 2-3 additional clinical entities to increase the study population of women with varied racial, ethnic, and socioeconomic characteristics and expand the geographic reach. In addition, the period of collection of outcome data for infants was expanded through age six years. This allowed for a more comprehensive assessment of cognitive and motor developmental delays that may not be apparent in younger children.

PURPOSE 
The goal of this project was to strengthen the existing surveillance approach, increase the data available to answer key scientific and clinical questions, and better inform evidence-based, clinical best practices to enhance the lives of mothers, infants, and children affected by OUD by:

• Increasing diversity of MAT-LINK network through expanded geographic representation and greater representation of racial and ethnic minority populations. 
• Extending follow-up of children from two years through six years of age to assess cognitive and motor development. 
• Improving knowledge about maternal overdose, maternal infection, and infant outcomes, including NAS, and enhance clinical care of pregnant women with OUD and infants with prenatal opioid exposure.

KEY IMPACTS 
 Improving the quality of data: Promotion and increasing the consistency and representativeness of dataset 
MAT-LINK2 improved the overall quality of the MAT-LINK dataset through several activities, including improving the completeness and correctness of EHR data obtained from participating clinical sites, improving the consistency of data collection across participating sites, and improving the representativeness of the dataset by capturing more diverse populations in terms of geography, race and ethnicity, and insurance status in the dataset.

Providing more relevant, comprehensive data: Data to study the opioid overdose   
The expanded MAT-LINK dataset includes almost 6,000 parent-child dyads using EHR data from 7 geographically diverse clinical sites to monitor maternal, infant, and child long-term health outcomes associated with receiving medication for OUD during pregnancy. It includes several child follow-up variables related to health care encounters and referrals, vaccinations, and school-readiness for children through six years old.

Enhancing analytic resources: Machine learning to identify diagnostic codes 
This project implemented machine learning processes to analyze MAT-LINK data and improve accuracy in review of diagnostic data. The project utilized clustering analysis, a machine learning technique, to identify patterns in diagnostic codes within the MAT-LINK dataset for future explanatory and predictive modeling analyses.

PUBLICATIONS 
MAT-LINK2 Child Follow-up Data and User Guide. This site includes information on how to request the restricted data and user guide. The current data set focuses on pregnant woman, infant, and child health outcomes following certain exposures during pregnancy such as medication for opioid use disorder, polysubstance use, and cytomegalovirus

Polysubstance Use in Pregnancy: Surveillance, Interventions, and Next Steps. This Journal of Women’s Health publication describes the activities of the Centers for Disease Control and Prevention/National Center on Birth Defects and Developmental Disabilities team to address adverse maternal and child health outcomes from polysubstance use and gaps related to surveillance, routine screening, and prevention of polysubstance use during pregnancy.

Medication for Opioid Use Disorder During Pregnancy — Maternal and Infant Network to Understand Outcomes Associated with Use of Medication for Opioid Use Disorder During Pregnancy (MAT-LINK), 2014–2021. This report provides detailed description of a sentinel surveillance system for medication for opioid use disorder during pregnancy, including data sources, types of variables, methods for secure data transfer and storage, and the process for making data available for future analyses.

Patterns of Medication for Opioid Use Disorder During Pregnancy, 7 Clinical Sites, MATernaL and Infant clinical NetworK (MAT-LINK), 2014–2021. This Journal of Addiction Medicine manuscript describes patterns of medication for opioid use disorder (MOUD) during pregnancies in the opioid use disorder (OUD) cohort of MAT-LINK.

Using ICD Codes Alone May Misclassify Overdoses Among Perinatal People. This American Journal of Preventative Medicine manuscript explores the sensitivity, specificity, positive predictive value, and negative predictive value of ICD-9/10-CM codes for drug overdose events among people in MAT-LINK with medication for opioid use disorder during pregnancy.

Project Final Report. This final report describes the project's background, objectives, deliverables, lessons learned, and future considerations.