Prevalence of Hospitalized Live Births Affected by Alcohol and Drugs and Parturient Women Diagnosed with Substance Abuse at Liveborn Delivery: United States, 1999–2008

To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well
as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems
in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes
in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified
hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one
of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live
births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence
differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend
patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study
also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased
for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected
live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively
stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid.
The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women
to reduce the number of substance-affected live births.