Maternal Characteristics and Risk Factors Associated with Neonatal Abstinence Syndrome, Oregon 2012-2017
Abstract
Objectives: To determine which maternal characteristics and risk factors are associated with neonatal abstinence syndrome (NAS) diagnosis among Medicaid funded births.
Methods: We utilized Oregon Medicaid claims and linked vital statics data to identify women that delivered in an Oregon hospital from 2012-2017 with diagnosis of opioid use disorder (OUD) prenatally or at delivery. We included year of birth, age, race/ethnicity, education, rurality, parity, tobacco use, alcohol use, amphetamine use and prenatal medically assisted treatment as potential covariates. We assessed bivariate differences using chi-square or t-tests and estimated the odds of NAS using multivariate logistic regression. All analyses were completed in R 3.6.2.
Results: Among women with OUD and a Medicaid funded delivery (n=2,807), 15% of infants were diagnosed with NAS (n=423). Maternal age, race, education, parity and tobacco use did not significantly differ by NAS status. Controlling for maternal demographic factors, the odds of NAS was higher among women reporting fewer than 7 prenatal visits (OR: 1.64, 95% CI: 1.45, 1.84) and delivering in an urban hospital (OR: 1.52, 95% CI: 1.36-1.70) but lower among women with co-occurring amphetamine use (OR: 0.344, 95% CI: 0.29, 0.42).
Conclusions: The finding that amphetamine use is strongly inversely associated with NAS among this population is notable. Given the low plausibility that amphetamine use “protects” against NAS in this population, this finding may signal a potential confounding bias or other structural factor explaining the strong inverse association. Future research should explore potential biases that account for this association and how it can inform care for women with OUD.
Maternal Characteristics and Risk Factors Associated with Neonatal Abstinence Syndrome, Oregon 2012-2017
Objectives: To determine which maternal characteristics and risk factors are associated with neonatal abstinence syndrome (NAS) diagnosis among Medicaid funded births.
Methods: We utilized Oregon Medicaid claims and linked vital statics data to identify women that delivered in an Oregon hospital from 2012-2017 with diagnosis of opioid use disorder (OUD) prenatally or at delivery. We included year of birth, age, race/ethnicity, education, rurality, parity, tobacco use, alcohol use, amphetamine use and prenatal medically assisted treatment as potential covariates. We assessed bivariate differences using chi-square or t-tests and estimated the odds of NAS using multivariate logistic regression. All analyses were completed in R 3.6.2.
Results: Among women with OUD and a Medicaid funded delivery (n=2,807), 15% of infants were diagnosed with NAS (n=423). Maternal age, race, education, parity and tobacco use did not significantly differ by NAS status. Controlling for maternal demographic factors, the odds of NAS was higher among women reporting fewer than 7 prenatal visits (OR: 1.64, 95% CI: 1.45, 1.84) and delivering in an urban hospital (OR: 1.52, 95% CI: 1.36-1.70) but lower among women with co-occurring amphetamine use (OR: 0.344, 95% CI: 0.29, 0.42).
Conclusions: The finding that amphetamine use is strongly inversely associated with NAS among this population is notable. Given the low plausibility that amphetamine use “protects” against NAS in this population, this finding may signal a potential confounding bias or other structural factor explaining the strong inverse association. Future research should explore potential biases that account for this association and how it can inform care for women with OUD.