VW9 - PRENATAL SUBSTANCE EXPOSURE: PREVALENCE, MATERNAL ACCESS TO MEDICATION AND INFANT OUTCOMES, AND IMPACT ON STATE STRATEGIES FOR PREVENTION AND TREATMENT
Monday, April 15, 2024
7:30 AM – 8:30 AM PT
"Infants with NAS have high emergency department (ED) and rehospitalization rates, and NAS diagnosis at birth is associated with poor neurodevelopment outcomes by school age and low educational achievements in high school, potentially affecting the life trajectories of children. Estimation of both NAS rates and prenatal substance exposure rates in Medicaid covered births are important for federal policymakers in designing better targeted programs nationwide and for state policymakers in evaluating outcomes from state prevention and treatment efforts. A recent analysis using Medicaid covered births using found that between 2016 and 2020, the estimated rate of NAS in Medicaid experienced a 18% decline, while the estimated rate of prenatal substance exposure experienced a 3.6% increase. The increase in prenatal substance exposure that this analysis finds is concerning and coincides with reported increases in prenatal marijuana, alcohol, and other illicit drug use. The state-level variations show that some states have made strides in addressing NAS and prenatal substance exposure, while others have lagged behind. Policymakers at the state level can use the findings of this analysis to further investigate what type of substance use in particular is driving these trends. Researchers can investigate contextual factors that have impacted reduction in NAS and increase in prenatal substance exposure in order to understand how local factors and policy approaches can be adjusted to be most effective. Screening and treatment approaches would need to be adapted as therapeutic approaches differ between opioids, stimulants, tobacco, or alcohol. Preventing prenatal substance use and neonatal exposure are an important public health priority, as substance use, along with mental health conditions, are a leading underlying cause of maternal mortality and a significant portion of mothers with substance use disorder do not receive any treatment. However, medications for opioid use disorder (MOUD) are an effective treatment for OUD, but use of MOUD remains low. Using a multi-state Medicaid claims database on mother-child dyads, an analysis found that receipt of MOUD during pregnancy among women with OUD is associated with improved health services use by the infant. Use of MOUD prenatally was associated with 20% higher odds of the child receiving the recommended number of well child visit and 20% lower odds of an inpatient admissions. This finding is consistent with the hypothesis that when pregnant women are engaged in MOUD treatment, their children are also likely to receive the appropriate levels of care, avoiding acute service use like hospitalization which signifies exacerbation of symptoms. However, disparities affect access to MOUD. MOUD treatment was more common among White pregnant women with opioid-exposed births, compared to Black or Hispanic women. A higher percentage of non-Hispanic White women (48%) received MOUD during pregnancy compared to Hispanic women (37%) or non-Hispanic Black women (18%). Pregnant non-Hispanic Black women received no OUD treatment more often (56%) than pregnant Hispanic women (35%) or non-Hispanic White women (28%). These findings demonstrating disparities in accessing MOUD overlap with findings from a prior publication showing that Black or Hispanic race/ethnicity is associated with a lower likelihood of MOUD use. The disparity in accessing MOUD is present despite the fact that all of the women in the sample by default had health insurance coverage. These findings may reflect the impacts of a range of economic and social barriers, including structural racism, that Black and Hispanic women need to overcome to access services beyond having health insurance Access to SUD treatment can help keep families together and parents in treatment, with the best outcomes for both mother and child. Continued investment at the federal level is important and sustained effort to incentivize adoption of innovative payment models that foster collaboration among maternity care providers and primary care providers can help improve screening for and connect women to SUD services. Partnerships between state public health, Medicaid and human services agencies can support improved identification and receipt of services, including MOUD, psychosocial services, housing, income support, employment, child care and other vital services that mothers with substance use disorder need to access treatment and stay in recovery."