Prevalence of Maternal‐Risk Factors Related to Neonatal Abstinence Syndrome in a Commercial Claims Database: 2011‐2015

Abstract

Background Despite the rising incidence of neonatal abstinence syndrome (NAS), data evaluating trends in maternal risk factors associated with NAS have not been available for recent years, a period characterized by declining opioid prescriptions. The objective of this study was to examine the prevalence of opioid‐ and non–opioid‐related factors associated with NAS, and by mutually exclusive subgroups of deliveries without prescription‐opioid use, with prescription‐opioid use, and with opioid‐use disorder (OUD). Methods A cohort of pregnancies resulting in live births in a commercial claims data base in 2011–2015 was identified. Examples of maternal risk factors of interest included antepartum prescription‐drug use (e.g., opioids, selective serotonin reuptake inhibitors [SSRIs], antipsychotics) and nonprescription‐related factors (e.g., smoking, OUD). Results A total of 659 cases of NAS among 621,940 deliveries was identified. Among NAS deliveries, prescription opioids were the most commonly used drug‐class (39.0%). Adjusted relative risk (RR) for NAS was 5.43 (95% confidence interval [CI] 4.25–6.95), followed by SSRIs (20.9%; RR 3.16, CI 2.43–4.11); OUD was noted in 36.3% of the deliveries (RR 40.74, CI 22.64–73.32). In the subgroup of deliveries without a prescription opioid (33% of overall NAS deliveries), the absolute incidence of NAS was low (0.3 cases/1000 deliveries), and SSRIs were the most commonly used medication class (32.7%; RR 10.21, CI 7.28–14.31). In the subgroup of deliveries with an opioid prescription, the absolute incidence of NAS was 7.7/1000 (29% of all overall NAS deliveries), and 22.7% of these deliveries were exposed to one other psychotropic agent in addition to the opioid, most commonly an SSRI (18.0%). In the subgroup of deliveries with a diagnosis of OUD, the NAS incidence was high (214.3/1000 [36% of all NAS cases]). Conclusion A third of NAS deliveries did not have evidence of prescription opioids. Other psychotropic medications, especially SSRIs, were strong predictors of NAS in this stratum but had no relevance among deliveries with OUD, suggesting varying etiologies and the need for tailored preventive approaches to reduce NAS effectively.

Neonatal Abstinence Syndrome and Childhood Mental Health Conditions, 2009–2015: Commercial Versus Medicaid Populations

“…In recent years, NAS has become synonymous with neonatal opioid withdrawal syndrome, which is distinct from NAS related to other substances. Although recent literature has examined rates of prescription opioid use among pregnant women (12), a gap in the literature exists in quantifying the rates of opioid use among pregnant women by insurance status.…”

Maternal and iatrogenic neonatal opioid withdrawal syndrome: Differences and similarities in recognition, management, and consequences

“…In fact, in utero exposure to two or more psychotropic medications combined with opioids has been associated with a twofold increased risk of opioid withdrawal requiring pharmacotherapy (Huybrechts et al, 2017), the risk varying with the type of psychotropic medication or polysubstance use (Dave et al, 2019;Huybrechts et al, 2017;Isemann et al, 2017). Moreover, maternal opioid misuse may increase the risk of mNOWS requiring pharmacotherapy compared to maternal opioid use as prescribed (Dave et al, 2019;Desai et al, 2015). Tobacco and alcohol are commonly used substances, and maternal tobacco has been found to exacerbate mNOWS symptoms in the neonate (Jones et al, 2013).…”

“…Concurrent maternal use of benzodiazepines is associated with an increase in the risk of mNOWS in opioid exposed neonates (Huybrechts et al, 2017;Swortfiguer et al, 2005). Maternal use of other substances such as psychotropic substances including gabapentin also increases the incidence of mNOWS (Dave et al, 2019;Desai et al, 2015;Huybrechts et al, 2017;Wachman et al, 2011).…”

Prediction model for nonopiate‐induced neonatal abstinence syndrome

“…In recent years, the prevalence of psychiatric‐complicated pregnancies has remained at approximately 3% 5,6 . The prevalence of nonopiate‐induced NAS is not well understood but it is thought to be lower than that of opiate‐induced NAS 4,7–9 . However, the risk of developing NAS may result in longer hospital stays than usual.…”