Clinical Guidance For Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants
In 2015, more than 27 million people in the United States reported current use of an illicit drug or misuse of prescription drugs in the past 30 days. The number of women of childbearing age, defined as ages 15–44, who reported past-month heroin use increased to 109,000 in 2013–2014, an increase of 31 percent from 2011–2012. The number of women ages 15–44 who reported past-month misuse of prescription pain relievers such as OxyContin© increased to 98,000 in the same period, an increase of 5.3 percent. The Centers for Disease Control and Prevention estimates that one-third of reproductive-age women enrolled in Medicaid and more than one-quarter of those with private insurance filled a prescription for an opioid pain medication each year between 2008 and 2012 . The prevalence of OUD during pregnancy more than doubled between 1998 and 2011 to 4 per 1,000 deliveries .
Neonatal abstinence syndrome is a group of physiologic and neurobehavioral signs of withdrawal that may occur in a newborn who was exposed to psychotropic substances (e.g., opioids) in utero. Opioid use, whether resulting from prescription misuse or from illicit use, has consequences for the mother–infant dyad, with anywhere from 50 to 80 percent of opioid-exposed infants developing NAS.
From 2009 to 2012, the number of infants diagnosed with NAS increased from 3.4 to 5.8 per 1,000 hospital births, with more than 20,000 infants diagnosed with NAS in 2012. The rate of NAS per 1,000 hospital births is not uniform across the nation; rates in rural regions are generally higher than those in urban regions. The increase in numbers of infants with NAS, along with other complications, and approach the hospital takes to treating NAS contributes to substantially increased hospital costs, with an average mean charge of $93,400 in 2012 dollars.