Hospital costs are increased among children with exposure to substance use during pregnancy for up to 20 years of age, but this can be reduced through out-of-home care, according to a recent study published in JAMA Pediatrics.
Takeaways
- Children exposed to substance use during pregnancy have higher hospital costs up to age 20 years.
- The cost for neonatal abstinence syndrome (NAS) increased from $731.8 million in 2009 to $2.5 billion in 2016.
- Out-of-home care significantly reduces hospital readmission risks and associated costs for these children.
- Prenatal substance exposure, particularly NAS, leads to higher rates of hospital readmission.
- Out-of-home care lowers the adjusted relative risk of readmission from 1.28 to 1.01 within the first 2 years after birth.
There is a significant burden on health services caused by offspring exposure to maternal substance use during pregnancy in the United States, with costs for neonatal abstinence syndrome (NAS) increasing 3-fold in 7 years from $731.8 million in 2009 to $2.5 billion in 2016. Additionally, NAS has been linked to increased rates of rehospitalization.
Data about how lifestyle and environment impact NAS development in children exposed to substance use during pregnancy is lacking. Additionally, there is a need to evaluate the mediating effect of any out-of-home care.
Investigators conducted a study to evaluate the impact of out-of-home care on the association between substance use during pregnancy and costs at birth. The Perinatal Data Collection was assessed for maternal and infant birth data from July 1, 2001, to December 31, 2020, in New South Whales (NSW).
The Centre for Health Record Linkage performed data linkage, connecting Perinatal Data Collection to other NSW population databases. Substance use was the primary exposure of the study, defined using International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, Australian Modification codes.
There were 7 groups created for participating infants, with newborn birth records used to determine the classification of substance use during pregnancy. Children exposed to substance use during pregnancy were compared to those without any known exposure.
Prenatal exposure was classified into 6 groups: maternal smoking only, maternal alcohol misuse only, both maternal smoking and alcohol misuse, maternal mental or behavioral disorders, psychoactive substance misuse without diagnosis, prenatal substance exposure diagnosis, and NAS diagnosis.
Data about out-of-home care was obtained from the NSW Department of Communities and Justice and included demographic characteristics, child protection history, and types of placements. This data was linked to hospital readmission risk, defined by authors as, “any inpatient hospital admission after birth discharge.”
There were 1,820,655 live births included in the analysis, with a mean maternal age of 30.8 years. Prenatal substance exposure was reported in 114.9 per 1000 livebirths and NAS in 3.26 per 1000 livebirths. Premature birth was reported in 10.5% of infants with prenatal substance exposure, low birth weight in 11.4%, and special care unit admission in 2.5%.
Children with exposure to substance use during pregnancy were at an increased risk of receiving out-of-home care, with 24.6% entering out-of-home care by 6 months vs 19.8% without exposure. At least 1 patient readmission was reported in 43.4% vs 38.3%, respectively.
The relative risk (RR) for inpatient readmission persisted in offspring with prenatal substance exposure for up to 20 years, ranging from 1.05 to 1.12. Readmission was more likely in children exposed to smoking only, with a prenatal substance exposure diagnosis, and with NAS.
Children with NAS had the highest RR for readmission of 1.21 in the first 5 years. This persisted into early adulthood with a range from 1.19 to 1.41. A longer hospital stay during birth was also reported in infants with NAS, at approximately 11 days vs 4.2 days for children diagnosed with prenatal drug exposure.
Higher hospital costs were also linked to prenatal substance use exposure, with an adjusted mean difference of $1585 per child. The increased cost was especially high in children with NAS, incurring $19,404 more than those without prenatal substance exposure.
A mediating effect was observed from out-of-home care. Children with NAS had an adjusted RR of 1.28 for readmission within the first 2 years of age vs those with no exposure, but any care arrangement reduced this RR to 1.01, indicating a 27% reduced risk of readmission.
These results indicated out-of-home care mediates the relationship between prenatal substance exposure and health care costs. Investigators recommended further studies evaluate the underlying factors behind this association.
Reference
Lee E, Schofield D, Dronavalli M, et al. Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood. JAMA Pediatr. 2024. doi:10.1001/jamapediatrics.2024.2281
