Children exposed to substances during pregnancy are at high risk of facing a range of negative health outcomes, including neonatal abstinence syndrome (NAS). This condition, where a baby is born experiencing withdrawal symptoms from drugs they were exposed to in utero, imposes a significant burden on the child, the family, and the healthcare system. In the United States, between 2009 and 2016, the costs associated with birth admissions for NAS tripled, jumping from $731.8 million to $2.5 billion.
A new study published in JAMA Pediatrics sheds light on the longitudinal impact of prenatal substance exposure. Researchers examined the relationship between maternal use of tobacco, alcohol, illicit drugs, and the misuse of prescription drugs during pregnancy, focusing on how these factors influence out-of-home care, hospital utilization, length of hospital stay, and healthcare costs from birth through young adulthood. By analyzing over 1.6 million healthcare records in New South Wales (NSW), the study found that prenatal substance use contributed to an excess of $84 million in hospital costs. These increased costs were driven by longer hospital stays, a greater need for special or intensive care, and later hospitalizations, commonly due to respiratory illnesses and mental health or behavioral disorders.
Tragically, this study found that children with prenatal substance exposure were more likely to be readmitted to the hospital by one year of age for reasons such as neglect, maltreatment, and misuse. Those born with NAS were particularly vulnerable, as they faced a two-fold higher risk of later hospitalization for mental health issues. Moreover, their hospital admission costs at birth were $12,000 higher compared to children without such exposure.
This study also highlighted that although one in four children with prenatal substance exposure entered out-of-home care by six months of age, this intervention reduced healthcare costs by $16 million and lowered the risk of hospital readmission for children with NAS by almost 30%. Out-of-home care, in this context, refers to the court-ordered placement of a child under 18 in foster care, relative care, adoption, or residential care due to safety risks in their biological home.
These findings underscore the importance of comprehensive drug policies that emphasize prevention and supportive services for pregnant mothers and families struggling with substance use. By intervening early and providing targeted support, we can mitigate the long-term effects of prenatal substance exposure, help keep families together, and reduce the burden on the healthcare system.
References:
Lee, E., Schofield, D., Dronavalli, M., Lawler, K., Uebel, H., Burns, L., Bajuk, B., Page, A., Gu, Y., Eastwood, J., Dickson, M., Green, C., Dicair, L., & Oei, J. L. (2024). Health care needs and costs for children exposed to prenatal substance use to adulthood. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.2281
