Maternal Opioid-Related Diagnoses, Neonatal Abstinence Syndrome Rates Both Rising

Ashley H. Hirai, PhD

Through 2014 there has been significant increases in both neonatal abstinence syndrome (NAS) and maternal opioid use disorder, but some of the more recent statistics regarding this trend is not yet known.

A team, led by Ashley H. Hirai, PhD, Maternal and Child Health Bureau, Health Resources and Services Administration Department of Health and Human Services, examined national and state variations in NAS and maternal opioid-related diagnoses (MOD) rates in 2017, while describing national and state changes since 2010.

Study Parameters

In the repeated cross-sectional analysis, the investigators analyzed data from the 2010-2017 Healthcare Cost and Utilization Project’s National Inpatient Sample and State Inpatient Databases, an all-payer compendium of hospital discharge records from community nonrehabilitation hospitals in 47 states and Washington D.C.

The investigators sought main outcomes of NAS rates per 1000 birth hospitalizations and MOD rates per 1000 deliver hospitalizations.

Overall, there were 751,037 birth hospitalizations and 748,239 deliver hospitalizations in the national sample in 2017. Of this sample, there were 5375 newborns with NAS and 6065 women with MOD documented in the discharge record. The mean gestational age was 38.4 weeks and the mean maternal age was 28.8 years old.

Increasing Rates

Between 2010-2017, the estimated NAS rate significantly increased by 3.3 per 1000 birth hospitalizations (95% CI, 2.5-4.2), from 4.0 (95% CI, 3.3-4.7) to 7.3 (95% CI, 6.8-7.7).

The researchers found that the estimated MIOD rate significantly increased by 4.6 per 1000 delivery hospitalizations (95% CI, 3.9-5.4), from 3.5 (95% CI, 3.0-4.1) to 8.2 (95% CI, 7.7-8.7).

The larger increases for MOD when compared to NAS rates occurred with new International Classification of Disease, 10th Revision, Clinical Modification codes in 2016.

Using a census of 47 state databases in 2017, NAS rates ranged from 1.3 per 1000 birth hospitalizations in Nebraska to 53.5 per 1000 birth hospitalizations in West Virginia. Maine (31.4), Vermont (29.4), Delaware (24.2), and Kentucky (23.9) also exceeded 20 per 1000 birth hospitalizations.

MOD rates ranged from 1.7 per 1000 delivery hospitalizations in Nebraska to 47.3 per 1000 delivery hospitalizations in Vermont. West Virginia (40.1), Maine (37.8), Delaware (24.3), and Kentucky (23.4) also exceeded 20 per 1000 delivery hospitalizations.

Overall, between 2010-2017 both NAS and MOD rates increased significantly for all states except for Nebraska and Vermont, which only had MOD increases.

“In the US from 2010 to 2017, estimated rates of NAS and MOD significantly increased nationally and for the majority of states, with notable state-level variation,” the authors wrote.

Opioid Issues with Offspring

Recently, investigators found parental and adolescent medical prescription opioid use and misuse were directly linked.

Using data from the annual 2015-2017 National Survey on Drug Use and Health, a team from Columbia University Vagelos College of Physicians and Surgeons found parental medical prescription stimulant use was linked with adolescent medical prescription opioid use (aOR, 1.40; 95% CI, 1.02-1.91), while parental marijuana use (aOR, 1.84; 95% CI, 1.13-2.99), parent-adolescent conflict (aOR, 1.26; 95% CI, 1.05-1.52), and adolescent depression (aOR, 1.75; 95% CI, 1.26-2.44) were linked with adolescent prescription opioid misuse.

In addition, Adolescent delinquency (aOR, 1.55; 95% CI, 1.38-1.74) and perceived schoolmates’ drug use (aOR, 2.87; 95% CI, 1.95-4.23) were associated with adolescent misuse, as well as more weekly with medical use (aORs, 1.13; 95% CI, 1.05-1.22 and aOR, 1.61; 95% CI, 1.32-1.96], respectively).

The study, “Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017,” was published online in JAMA.