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Original Investigation
January 12, 2021

Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses in the US, 2010-2017

Author Affiliations
  • 1Maternal and Child Health Bureau, Health Resources and Services Administration Department of Health and Human Services, Rockville, Maryland
  • 2Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention Department of Health and Human Services, Atlanta, Georgia
  • 3Commissioned Corps Public Health Service Department of Health and Human Services, Rockville, Maryland
  • 4Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality Department of Health and Human Services, Rockville, Maryland
  • 5West Virginia University, School of Public Health, Morgantown
  • 6formerly with the Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality Department of Health and Human Services, Rockville, Maryland at the time of analysis
  • 7Department of Pediatrics, Vanderbilt Center for Child Health Policy, Nashville, Tennessee
  • 8Department of Health Policy, Vanderbilt Center for Child Health Policy, Nashville, Tennessee
  • 9Division of Neonatology, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA. 2021;325(2):146-155. doi:10.1001/jama.2020.24991
Key Points

Question  In the US from 2010 to 2017, what were national-level and state-level rates in neonatal abstinence syndrome (NAS) and maternal opioid-related diagnoses (MOD)?

Findings  In this repeated cross-sectional analysis including 11.8 million hospitalizations from 47 states and the District of Columbia, the national estimated rate of NAS was 7.3 per 1000 birth hospitalizations and the rate of MOD was 8.2 per 1000 delivery hospitalizations in 2017. From 2010 to 2017, estimated rates significantly increased nationally and for the majority of states, with substantial state-level variation.

Meaning  In the US, NAS and MOD rates increased from 2010 to 2017, with notable state-level variation.

Abstract

Importance  Substantial increases in both neonatal abstinence syndrome (NAS) and maternal opioid use disorder have been observed through 2014.

Objective  To examine national and state variation in NAS and maternal opioid-related diagnoses (MOD) rates in 2017 and to describe national and state changes since 2010 in the US, which included expanded MOD codes (opioid use disorder plus long-term and unspecified use) implemented in International Classification of Disease, 10th Revision, Clinical Modification.

Design, Setting, and Participants  Repeated cross-sectional analysis of the 2010 to 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 the District of Columbia.

Exposures  State and year.

Main Outcomes and Measures  NAS rate per 1000 birth hospitalizations and MOD rate per 1000 delivery hospitalizations.

Results  In 2017, there were 751 037 birth hospitalizations and 748 239 delivery hospitalizations in the national sample; 5375 newborns had NAS and 6065 women had MOD documented in the discharge record. Mean gestational age was 38.4 weeks and mean maternal age was 28.8 years. From 2010 to 2017, the estimated NAS rate significantly increased by 3.3 per 1000 birth hospitalizations (95% CI, 2.5-4.1), from 4.0 (95% CI, 3.3-4.7) to 7.3 (95% CI, 6.8-7.7). The estimated MOD 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). Larger increases for MOD vs NAS rates occurred with new International Classification of Disease, 10th Revision, Clinical Modification codes in 2016. From 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, with Maine (31.4), Vermont (29.4), Delaware (24.2), and Kentucky (23.9) also exceeding 20 per 1000 birth hospitalizations, while MOD rates ranged from 1.7 per 1000 delivery hospitalizations in Nebraska to 47.3 per 1000 delivery hospitalizations in Vermont, with West Virginia (40.1), Maine (37.8), Delaware (24.3), and Kentucky (23.4) also exceeding 20 per 1000 delivery hospitalizations. From 2010 to 2017, NAS and MOD rates increased significantly for all states except Nebraska and Vermont, which only had MOD increases.

Conclusions and Relevance  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.

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