Neonatal Abstinence Syndrome in Iowa

Iowa

Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome occurring in newborns. NAS is most commonly caused by fetal exposure to maternal opioid use, and is also associated with benzodiazepine, barbiturate and antidepressants. Data linking NAS with other maternal drug use is inconclusive, but use of chemically addictive substances during pregnancy — including selective serotonin reuptake inhibitor (SSRI) antidepressants — can cause symptoms characteristic of withdrawal in newborns. Opioid use during pregnancy has increased in the United States over the last 20 years, with corresponding increases in NAS. Between 55% and 94% of infants exposed to opioids during gestation experience withdrawal symptoms. Symptoms of NAS can include tremors, increased muscle tone, high-pitched crying, seizures, feeding difficulties and trouble gaining weight. NAS can cause long-term symptoms in children as well, such as developmental delays, growth problems and hearing and vision problems.

Newborns with NAS stay in the hospital an average of 1.8 days longer than newborns without NAS, which is associated with an increased hospital cost of $1,685 per day. Medicaid covered 83% of NAS-related births in 2016, costing the U.S. $527.7 million.

According to America’s Health Rankings analysis, the prevalence of neonatal abstinence syndrome is higher among:

• American Indian/Alaska Native and white infants compared with Black, Hispanic and Asian/Pacific Islander infants. American Indian/Alaska Native infants have a prevalence more than 24 times higher than Asian/Pacific Islander infants.
• Infants in nonmetropolitan areas compared with infants in metropolitan areas. 
• Infants in lower-income areas compared with those in higher-income areas.
• Male newborns compared with female newborns.

Treating maternal opioid dependence before and during pregnancy is crucial to reducing cases of NAS. 

The American College of Obstetricians and Gynecologists has several recommendations regarding opioid use during pregnancy, including: 

• Universal early screening, preferably at the first prenatal visit.
• Minimizing the use of opioids for chronic pain and highlighting alternative therapies.
• Increasing access to contraceptive services among women of reproductive age.

Providers can also refer to the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, which includes specific guidance for pregnant patients.

Mandated reporting of NAS cases in hospitals helps guide programs and services with consistent and reliable data on NAS incidence, trends and associated factors. Reporting can also help identify more cases of maternal opioid use disorder, improving data critical to developing effective interventions.

Healthy People 2030 has multiple goals relating to neonatal abstinence syndrome, including increasing abstinence from illicit drugs among pregnant women and reducing the proportion of women who use illicit opioids during pregnancy.

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