Maternal and Child Health Journal

, Volume 17, Issue 4, pp 667–676

Prevalence of Hospitalized Live Births Affected by Alcohol and Drugs and Parturient Women Diagnosed with Substance Abuse at Liveborn Delivery: United States, 1999–2008

Article

Abstract

To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

Keywords

Alcohol Drug Live birth Neonatal drug withdrawal syndrome Trend analysis 

References

  1. 1.
    Susbstance Abuse and Mental Health Services Administration (SAMSHA). (2009). Results from the 2008 National Survey on Drug Use and Health: National findings. Rockville, MD: SAMSHA, Office of Applied Studies. NSDUH Series H-36, HHS Publication No. SMA 09-4434.Google Scholar
  2. 2.
    Warren, K. R., Hewitt, B. G., & Thomas, J. D. (2011). Fetal alcohol spectrum disorders: Research challenges and oppourtunities. Alcohol Research & Health, 34(1), 4–14.Google Scholar
  3. 3.
    Bertrand, J., Floyd, R. L., Weber, M. K., O’Connor, M., Riley, E. P., Johnson, K. A., et al. (2004). Fetal alcohol syndrome: Guidelines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  4. 4.
    Addis, A., Moretti, M. E., Ahmed Syed, F., Einarson, T. R., & Koren, G. (2001). Fetal effects of cocaine: An updated meta-analysis. Reproductive Toxicology, 15(4), 341–369.PubMedCrossRefGoogle Scholar
  5. 5.
    Gouin, K., Murphy, K., & Shah, P. S. (2011). Effects of cocaine use during pregnancy on low birthweight and preterm birth: Systematic review and metaanalyses. American Journal of Obstetrics and Gynecology, 204, 340.e1–340.e12.Google Scholar
  6. 6.
    Savitz, D. A., & Murnane, P. (2010). Behavioral influences on preterm birth: A review. Epidemiology, 21(3), 291–299.PubMedCrossRefGoogle Scholar
  7. 7.
    Lipshultz, S. E., Frassica, J. J., & Orav, E. J. (1991). Cardiovascular abnormalities in infants prenatally exposed to cocaine. Journal of Pediatrics, 118(1), 44–51.PubMedCrossRefGoogle Scholar
  8. 8.
    Ladhani, N. N., Shah, P. S., & Murphy, K. E. (2011). Prenatal amphetamine exposure and birth outcomes: A systematic review and metaanalysis. American Journal of Obstetrics and Gynecology, 205, 219.e1–219.e7.Google Scholar
  9. 9.
    Derauf, C., Kekatpure, M., Neyzi, N., Lester, B., & Kosofsky, B. (2009). Neuroimaging of children following prenatal drug exposure. Seminars in Cell & Developmental Biology, 20(4), 441–454.CrossRefGoogle Scholar
  10. 10.
    Roussotte, F., Soderberg, L., & Sowell, E. (2010). Structural, metabolic, and functional brain abnormalities as a result of prenatal exposure to drugs of abuse: Evidence from neuroimaging. Neuropsychology Review, 20(4), 376–397.PubMedCrossRefGoogle Scholar
  11. 11.
    American Academy of Pediatrics Committee on Drugs. (1998). Neonatal drug withdrawal. Pediatrics, 101(6), 1079–1088.Google Scholar
  12. 12.
    Robbins, J. M., Bird, T. M., Tilford, J. M., Reading, J. A., Cleves, M. A., Aitken, M. E., et al. (2006). Reduction in newborns with discharge coding of in utero alcohol effects in the United States, 1993 to 2002. Archives of Pediatrics and Adolescent Medicine, 160(12), 1224–1231.PubMedCrossRefGoogle Scholar
  13. 13.
    National Center for Health Statistics. (2011). Healthy people 2010 final review. Hyattsville, MD: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics [cited November 29, 2011]. Available from: http://www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review.pdf.
  14. 14.
    Dicker, M., & Leighton, E. A. (1994). Trends in the US prevalence of drug-using parturient women and drug-affected newborns, 1979 through 1990. American Journal of Public Health, 84(9), 1433–1438.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Donnell, M., Nassar, N., Leonard, H., Hagan, R., Mathews, R., Patterson, Y., et al. (2009). Increasing prevalence of neonatal withdrawal syndrome: Population study of maternal factors and child protection involvement. Pediatrics, 123(4), e614–e621.PubMedCrossRefGoogle Scholar
  16. 16.
    Healthcare Cost and Utilization Project (HCUP). (2008). Introduction to the HCUP Nationwide Inaptient Sample (NIS). Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality [cited September 20, 2010]. Available from: http://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2008.jsp.
  17. 17.
    Centers for Medicare and Medicaid Services, National Center for Health Statistics. (2010). ICD-9-CM official guidelines for coding and reporting. Effective October 1, 2010 [cited December 1, 2010]. Available from: http://www.cdc.gov/nchs/data/icd9/icdguide10.pdf.
  18. 18.
    Healthcare Cost and Utilization Project (HCUP). (2011). Cost-to-charge ratio files. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality [cited April 17, 2012]. Available from: http://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp.
  19. 19.
    US Department of Labor Bureau of Labor Statistics. (2012). Consumer price index. Chained consumer price index for all urban consumers (C-CPI-U), US All Items. Series ID: SUUR0000SA0. Washington, DC: US Department of Labor [cited April 25, 2012]. Available from: http://data.bls.gov/cgi-bin/surveymost?su.
  20. 20.
    Healthcare Cost and Utilization Project (HCUP). (2011). NIS description of data elements. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality [cited March 29, 2011]. Available from: http://www.hcup-us.ahrq.gov/db/nation/nis/nisdde.jsp.
  21. 21.
    Cox, S., Posner, S. F., Kourtis, A. P., & Jamieson, D. J. (2008). Hospitalizations with amphetamine abuse among pregnant women. Obstetrics and Gynecology, 111(2 Pt 1), 341–347.PubMedCrossRefGoogle Scholar
  22. 22.
    Terplan, M., Smith, E. J., Kozloski, M. J., & Pollack, H. A. (2009). Methamphetamine use among pregnant women. Obstetrics and Gynecology, 113(6), 1285–1291.PubMedGoogle Scholar
  23. 23.
    Cox, S., Johnson, C. H., Meikle, S., Jamieson, D. J., & Posner, S. F. (2007). Trends in rates of hospitalization with a diagnosis of substance abuse among reproductive-age women, 1998 to 2003. Womens Health Issues, 17(2), 75–83.PubMedCrossRefGoogle Scholar
  24. 24.
    National Drug Intelligence Center. (2011). National drug threat assessment 2011. Washington, DC: US Department of Justice, National Drug Intelligence Center [cited September 20, 2011]. Available from: http://www.justice.gov/ndic/pubs44/44849/44849p.pdf.
  25. 25.
    Substance Abuse and Mental Health Services Administration (SAMSHA). (2011). Results from the 2010 National Survey on Drug Use and Health: Summary of national findings. Rockville, MD: SAMSHA, Office of Applied Studies. NSDUH Series H-41, HHS Publication No. SMA 11-4658.Google Scholar
  26. 26.
    Compton, W. M., & Volkow, N. D. (2006). Major increases in opioid analgesic abuse in the United States: Concerns and strategies. Drug and Alcohol Dependence, 81(2), 103–107.PubMedCrossRefGoogle Scholar
  27. 27.
    Substance Abuse and Mental Health Services Administration (SAMSHA). (2010) Treatment episode data set (TEDS): 19982008. National Admissions to Substance Abuse Treatment Services. Rockville, MD: SAMSHA, Office of Applied Studies. DASIS Series: S-50, HHS Publication No. SMA 09-4471.Google Scholar
  28. 28.
    Centers for Disease Control and Prevention. (2010). Emergency department visits involving nonmedical use of selected prescription drugs—United States, 2004–2008. MMWR, 59(23), 705–709.Google Scholar
  29. 29.
    Cox, S., Kuo, C., Jamieson, D. J., Kourtis, A. P., McPheeters, M. L., Meikle, S. F., et al. (2011). Poisoning hospitalisations among reproductive-aged women in the USA, 1998–2006. Injury Prevention, 17(5), 332–337.PubMedCrossRefGoogle Scholar
  30. 30.
    Coben, J. H., Davis, S. M., Furbee, P. M., Sikora, R. D., Tillotson, R. D., & Bossarte, R. M. (2010). Hospitalizations for poisoning by prescription opioids, sedatives, and tranquilizers. American Journal of Preventive Medicine, 38(5), 517–524.PubMedCrossRefGoogle Scholar
  31. 31.
    Bohnert, A. S., Fudalej, S., & Ilgen, M. A. (2010). Increasing poisoning mortality rates in the United States, 1999–2006. Public Health Reports, 125(4), 542–547.PubMedGoogle Scholar
  32. 32.
    Paulozzi, L. J., & Annest, J. L. (2007). US data show sharply rising drug-induced death rates. Injury Prevention, 13(2), 130–132.PubMedCrossRefGoogle Scholar
  33. 33.
    Paulozzi, L. J., & Centers for Disease Control and Prevention (CDC). (2011). Drug-induced deaths: United States, 2003–2007. MMWR Surveillance Summaries, 60(suppl), 60–61.Google Scholar
  34. 34.
    Harder, V. S., & Chilcoat, H. D. (2007). Cocaine use and educational achievement: understanding a changing association over the past 2 decades. American Journal of Public Health, 97(10), 1790–1793.PubMedCrossRefGoogle Scholar
  35. 35.
    Substance Abuse and Mental Health Services Administration (SAMSHA). (2009). Results from the 2008 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: SAMSHA, Office of Applied Studies [cited August 2, 2011]. Available from: http://oas.samhsa.gov/NSDUH/2K8NSDUH/tabs/INDEX.PDF.
  36. 36.
    Henderson, J., Gray, R., & Brocklehurst, P. (2007). Systematic review of effects of low-moderate prenatal alcohol exposure on pregnancy outcome. BJOG, 114(3), 243–252.PubMedCrossRefGoogle Scholar
  37. 37.
    Ventura, S. J., Martin, J. A., Curtin, S. C., Menacker, F., & Hamilton, B. E. (2001). Births: Final data for 1999. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  38. 38.
    Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Mathews, T. J., & Osterman, M. J. K. (2010). Births: Final data for 2008. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  39. 39.
    Havens, J. R., Simmons, L. A., Shannon, L. M., & Hansen, W. F. (2009). Factors associated with substance use during pregnancy: Results from a national sample. Drug and Alcohol Dependence, 99(1–3), 89–95.PubMedCrossRefGoogle Scholar
  40. 40.
    Ethen, M. K., Ramadhani, T. A., Scheuerle, A. E., Canfield, M. A., Wyszynski, D. F., Druschel, C. M., et al. (2009). Alcohol consumption by women before and during pregnancy. Maternal and Child Health Journal, 13(2), 274–285.PubMedCrossRefGoogle Scholar
  41. 41.
    Diekman, S. T., Floyd, R. L., Découflé, P., Schulkin, J., Ebrahim, S. H., & Sokol, R. J. (2000). A survey of obstetrician-gynecologists on their patients’ alcohol use during pregnancy. Obstetrics and Gynecology, 95(5), 756–763.PubMedCrossRefGoogle Scholar
  42. 42.
    Anderson, B. L., Dang, E. P., Floyd, R. L., Sokol, R., Mahoney, J., & Schulkin, J. (2010). Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients’ use of alcohol. Journal of Addiction Medicine, 4(2), 114–121.PubMedCrossRefGoogle Scholar
  43. 43.
    Roberts, S. C., & Nuru-Jeter, A. (2011). Universal alcohol/drug screening in prenatal care: A strategy for reducing racial disparities? Questioning the assumptions. Maternal and Child Health Journal, 15(8), 1127–1134.PubMedCrossRefGoogle Scholar
  44. 44.
    Ellsworth, M. A., Stevens, T. P., & D’Angio, C. T. (2010). Infant race affects application of clinical guidelines when screening for drugs of abuse in newborns. Pediatrics, 125(6), e1379–e1385.PubMedCrossRefGoogle Scholar
  45. 45.
    Gavin, N. I., Adams, E. K., Hartmann, K. E., Benedict, M. B., & Chireau, M. (2004). Racial and ethnic disparities in the use of pregnancy-related health care among Medicaid pregnant women. Maternal and Child Health Journal, 8(3), 113–126.PubMedCrossRefGoogle Scholar
  46. 46.
    Fussell, H. E., Rieckmann, T. R., & Quick, M. B. (2011). Medicaid reimbursement for screening and brief intervention for substance misuse. Psychiatric Services (Washington, D. C.), 62(3), 306–309.CrossRefGoogle Scholar
  47. 47.
    Lester, B. M., Andreozzi, L., & Appiah, L. (2004). Substance use during pregnancy: Time for policy to catch up with research. Harm Reduction Journal, 1(5), 1–44.Google Scholar
  48. 48.
    Guttmacher Institute. (2011). State policies in briefsubstance abuse during pregnancy (as of November 1, 2011). [cited November 23, 2011]. Available from: http://www.guttmacher.org/statecenter/spibs/spib_SADP.pdf.
  49. 49.
    Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, brief intervention, and referral to treatment (SBIRT): Toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 7–30.PubMedCrossRefGoogle Scholar
  50. 50.
    Madras, B. K., Compton, W. M., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W. (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence, 99(1–3), 280–295.PubMedCrossRefGoogle Scholar
  51. 51.
    ACOG Committee Opinion No. 422 (2008) At-risk drinking and illicit drug use: Ethical issues in obstetric and gynecologic practice. Obstetrics and Gynecology, 112(6), 1449–1460.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.CSR IncorporatedArlingtonUSA

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