A new study conducted by researchers at the U.S. Department of Health and Human Services (HHS) shows that the rates of pregnant women diagnosed with opioid use disorder and of babies born with withdrawal symptoms increased from 2010-2017. The study, published today in JAMA indicates that mothers with opioid-related diagnoses documented at delivery increased by 131%. Additionally, the incidence of babies born with withdrawal symptoms, known as neonatal abstinence syndrome or NAS, increased by 82% nationally over the same period. Increases were seen for nearly all states and demographic groups.
The Health Resources and Services Administration (HRSA) of HHS led this study in collaboration with the Centers for Disease Control and Prevention (CDC), the Agency for Healthcare Research and Quality (AHRQ) and Vanderbilt University Medical Center to examine the trends in NAS and maternal opioid diagnoses in hospital records. The researchers analyzed 11.8 million records from community, non-rehabilitation hospitals in 47 states and the District of Columbia from 2010 through 2017 that were part of AHRQ’s Healthcare Cost and Utilization Project (HCUP).
“Our findings highlight substantial state variation with as many as 1 in 20 deliveries affected by opioids in West Virginia and Vermont, yet increased rates of opioid diagnoses were seen in nearly all states. Half of the states more than doubled their rates during the study period,” said lead author Ashley Hirai, Ph.D., of HRSA’s Maternal and Child Health Bureau (MCHB). “State-specific data are key to driving action and informing strategies to help prevent inappropriate opioid use and screen for and treat opioid use disorder in pregnancy.”
“We found that rural, white, and Medicaid populations continue to have the highest rates of maternal opioid-related diagnoses and neonatal abstinence syndrome,” said Jean Ko, Ph.D., Lead of the Maternal Health and Chronic Disease Team in CDC’s Division of Reproductive Health. “However, large variation by state highlight the importance of state-level strategies and initiatives to address the opioid crisis for pregnant and postpartum women and their infants.”
Additionally, the study showed plateaus in opioid diagnoses in heavily affected New England states that may suggest some progress. “We hope to see more state progress as newer data becomes available, but it’s unclear how the COVID-19 pandemic may have affected opioid use disorder and access to treatment,” said Pamela Owens, Ph.D., senior research scientist at AHRQ. “Continued monitoring is essential to help inform and evaluate national and state-based efforts to prevent and improve care for opioid-affected pregnancies.”
MCHB provides states and jurisdictions critical funding to address national and state identified priorities, including maternal substance use, through the Title V Maternal and Child Health Services Block Grant Program, which tracks NAS as an outcome measure. MCHB also funds the national data-driven quality improvement initiative known as the Alliance for Innovation on Maternal Health (AIM), which promotes “safety bundles” to improve care quality and standardization for pregnant and postpartum women with opioid use disorder.
As part of CDC’s five-point strategy to prevent opioid overdoses and harms, the Division of Reproductive Health (DRH) is working to prevent, identify, and improve access to treatment of opioid use disorder among women of reproductive age. CDC’s Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative (OMNI) is a Learning Community, that supports state teams to implement policies and programs to address the opioid crisis. CDC also supports Perinatal Quality Collaboratives to improve the quality of care for mothers and babies, including those affected by opioids.
AHRQ sponsors HCUP, which comprises a family of healthcare databases and related software tools and products developed through a Federal-State-Industry partnership. HCUP includes the largest collection of longitudinal hospital care data in the United States, and contains detailed all-payer, encounter-level information beginning in 1988. HCUP is a critical source for monitoring emergent health issues, such as the rise in opioid-related hospitalizations. HCUP Fast Stats provides easy access to the latest HCUP-based statistics for opioid-related hospitalizations and neonatal abstinence syndrome.