A recent retrospective cohort study published in JAMA Pediatrics has evaluated the long-term health outcomes and hospitalisation costs for children exposed to substance use during pregnancy. The study examines the association between substance exposure, out-of-home care, and hospital utilisation from birth up to age 20 years.

Study Design and Participants

This population-based study used data from liveborn infants in New South Wales, Australia, from 2001 to 2020. The data were derived from linked population birth records, hospital records, and out-of-home care information. The study analysed 1,820,655 live births, with a mean maternal age of 30.8 years. Of these births:

• 935,807 (51.4%) were male.
• Substance exposure included 5,946 newborns with neonatal abstinence syndrome, 1,260 with intrauterine drug exposure, and 202,098 exposed to substances such as tobacco, alcohol, and illicit or misused prescription drugs.
• 1,611,351 children had no known substance exposure during pregnancy.

Exposure and Main Outcomes

Substance use during pregnancy was assessed through neonatal abstinence syndrome diagnoses, intrauterine exposure to addictive drugs, and other substances (e.g., tobacco, alcohol). Main outcomes included hospital readmission rates, length of hospital stay, and associated hospitalisation costs from birth to age 20 years.

Key Findings

Hospital Costs and Readmissions

Children exposed to substance use during pregnancy incurred significantly higher hospital costs and readmission rates compared to non-exposed children:

• Birth Hospital Costs: Adjusted mean difference of A$1585 per child (US$1 = A$1.51; 95% CI, 1585-1586).
• Readmission Rates: 43.4% of exposed children had at least one readmission versus 38.3% of non-exposed children (adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07).
• Common Readmission Reasons: Respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioural disorders (RR, 1.36; 95% CI, 1.33-1.41).
• Excess Hospital Costs: Associated with substance use during pregnancy amounted to A$129.0 million in 2019-2020.

Impact of Out-of-Home Care

Mediation analysis revealed that engagement with out-of-home care significantly influenced hospitalisation outcomes and costs:

• Cost Reduction: Contact with out-of-home care reduced the associated health care costs by A$25.4 million.
• Readmission Risk: For children with neonatal abstinence syndrome, out-of-home care contact mediated about 30% of the readmission risk, reducing the adjusted RR from 1.28 (95% CI, 1.19-1.35) to 1.01 (95% CI, 0.98-1.02).

Conclusion and Relevance

The study concluded that children exposed to substance use during pregnancy incurred more hospital costs up to age 20 compared to non-exposed children. However, this burden was reduced with any contact with out-of-home care, providing valuable insights into strategies for mitigating health and financial impacts.

Source: JAMA Network