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. 2023 Dec;27(Suppl 1):14-22.
doi: 10.1007/s10995-023-03670-z. Epub 2023 May 23.

Prenatal Substance Exposure and Neonatal Abstinence Syndrome: State Estimates from the 2016-2020 Transformed Medicaid Statistical Information System

Kristina D West  1 , Mir M Ali  2 , Martin Blanco  2 , Brenda Natzke  3 , Linda Nguyen  3
Affiliations

Prenatal Substance Exposure and Neonatal Abstinence Syndrome: State Estimates from the 2016-2020 Transformed Medicaid Statistical Information System

Kristina D West et al. Matern Child Health J. 2023 Dec.

Erratum in

Abstract

Introduction: Estimating Neonatal Abstinence Syndrome (NAS) and prenatal substance exposure rates in Medicaid can help target program efforts to improve access to services.

Methods: The data for this study was extracted from the 2016-2020 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) Research Identifiable Files (RIF) and included infants born between January 1, 2016 and December 31, 2020 with a either a NAS diagnosis or prenatal substance exposure.

Results: Between 2016 and 2020, the estimated national rate of NAS experienced a 18% decline, while the estimated national rate of prenatal substance exposure experienced a 3.6% increase. At the state level in 2020, the NAS rate ranged from 3.2 per 1000 births (Hawaii) to 68.0 per 1000 births (West Virginia). Between 2016 and 2020, 28 states experienced a decline in NAS births and 20 states had an increase in NAS rates. In 2020, the lowest prenatal substance exposure rate was observed in New Jersey (9.9 per 1000 births) and the highest in West Virginia (88.1 per 1000 births). Between 2016 and 2020, 38 states experienced an increase in the rate of prenatal substance exposure and 10 states experienced a decline.

Discussion: Estimated rate of NAS has declined nationally, but rate of prenatal substance exposure has increased, with considerable state-level variation. The reported increase in prenatal substance exposure in the majority of US states (38) suggest that substances other than opioids are influencing this trend. Medicaid-led initiatives can be used to identify women with substance use and connect them to services.

Keywords: Neonatal abstinence syndrome; Prenatal; Substance use.

Plain language summary

What is already known about the topic? Neonatal Abstinence Syndrome (NAS) and prenatal substance exposure are significant risk factors for poor neurodevelopmental and mental health outcomes in early childhood. NAS birth rates have been increasing in the US since 2000 and the majority of NAS births are covered by Medicaid.What this article adds? This article estimates national and state-level prenatal substance exposure and NAS rates among Medicaid-covered infants born between 2016-2020 using data from the Transformed Medicaid Statistical Information System. This is the first study using post-2017 data to estimate national NAS rates. The findings can inform future federal and state policy efforts to improve access to screening, diagnosis and treatment among pregnant women with substance use disorder and infants with NAS.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
National trends in NAS and prenatal substance exposure. Prenatal substance exposure increased from 27.414 substance-exposed newborns per 1000 births in 2016 to 28.392 in 2020. NAS rates decreased from 15.220 infants with NAS diagnosis per 1000 births in 2016 to 12.423 in 2020. Year to year variance represents differences in each year’s rate compared to 2016
Fig. 2
Fig. 2
State NAS and prenatal substance exposure estimates, 2020. In 2020, the NAS rate ranged from 3.17 per 1000 births in the state of Hawaii to 67.95 per 1000 births in West Virginia. The lowest prenatal substance exposure rate ranged from 9.97 per 1000 births in New Jersey and to 88.13 per 1000 births in West Virginia
Fig. 3
Fig. 3
Percent change in NAS and prenatal substance exposure rates, 2020–2016: geographic distribution. Between 2016 and 2020, 28 states experienced a decline in NAS birth rate, ranging between − 31.9% (New Jersey) and − 1% (Hawaii). 38 states experienced an increase in the rate of prenatal substance exposure, ranging from 2.5% (Massachusetts) to 174.7% (Mississippi)
Fig. 4
Fig. 4
Percent change in NAS and prenatal substance exposure rates, 2020–2016: list of states. Between 2016 and 2020, 10 states had NAS rate increases above 10%. Three states had close to 100% increase in their prenatal substance exposure rates by 2020- South Dakota (101.4%), DC (98.9%) and Mississippi (92.4%). 29 states had more than 10% increase in their prenatal substance exposure rate, and three states had close to or above 100% increases (Wyoming, Utah, Missisippi)
Fig. 5
Fig. 5
State trends in 10 states with the highest NAS and prenatal substance exposure rates, 2020–2016. Among the 10 states with the highest NAS and prenatal substance exposure rates, 9 states had both decreasing NAS rates and increasing prenatal substance exposure rates with the exception of New Hampshire and Kentucky. In New Hampshire both prenatal substance exposure rate (from 41.58 in 2016 to 63.59 in 2020) and NAS rate (from 51.98 in 2016 to 52.80 in 2020) increased while Kentucky had declines in both prenatal substance exposure rates (from 63.52 in 2016 to 60.27 in 2020) and NAS rates (from 42.92 in 2016 to 35.83 in 2020)
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References

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