Substance use during pregnancy: impact on Colorado community hospital

Abstract

Background Neonatal Abstinence Syndrome (NAS) leads to increased length of stay (LOS), which leads to increased healthcare costs, and can cause financial burdens for hospitals. The purpose of the study was to determine the impact of substance use by pregnant women on a Colorado (CO) community hospital after state legalization of recreational cannabis. Methods Data were gathered retrospectively through the electronic health record at an inpatient facility and described 607 mothers and 419 newborns (total N = 1026) who tested positive for drugs (urinalysis or blood for mother and urine, meconium, or cord blood for newborns). Screening for drugs was at discretion of healthcare provider if mother reported use or newborn showed symptoms of NAS. The patients who were not screened or tested negative were excluded from consideration. Newborns exposed to cannabis were compared to those exposed to other drugs (opioids, methadone, cocaine, barbiturates, benzodiazepines, amphetamines) on costs of newborn hospitalization, based on type of newborn bed and length of stay (LOS). Group comparisons were done using Cochran-Armitage chi-square tests and two-sample t-tests. Results The proportion of screened patients testing positive for illicit and prescribed substances increased significantly from 2013 (33.4%) to 2017 (50.2%) (p < 0.001). The LOS of drug-exposed newborns increased significantly over the years (p < 0.0001). Newborns testing positive for cannabis were more likely to remain in a normal newborn nursery (NSY) bed (69.8%) than those testing positive for other drugs (27.7%), with an average hospital LOS (4.6 days) significantly shorter (p < 0.001) than that of other-drug exposed newborns (14.2 days). Combined healthcare costs for other-drug exposed newborns ($23,495,221) were significantly higher (p < 0.001) than for cannabis-exposed newborns ($2,885,139); both groups had significantly higher costs (p < 0.001) than normal healthy newborns ($2,166,649). Conclusion Drug-exposed newborns have a significant financial impact on hospital healthcare costs, largely due to more expensive bed placement and longer LOS.

Uso De Drogas Ilícitas Na Gestação E Suas Consequências Para Feto: Revisão Integrativa Da Literatura

“…Outra droga encontrada no trabalho foi a anfetamina, na qual o efeito sobre o feto ainda não são bem conhecidos, mas a ocorrência de alterações morfológicas e funcionais do sistema nervoso, alterações cardíacas e desenvolvimento intrauterino inadequado foram demostradas em alguns trabalhos 24,19,20,27 .…”

“…Em relação ao tempo de internação da gestante e recém-nascido, os estudos 19,30,33 deste trabalho mostraram um aumento de 3 dias na internação, sendo necessário o uso da Unidade de Terapia Intensiva (UTI) 19 . Os recém-nascidos expostos ao cannabis, crack e cocaína necessitaram de internação em UTI por apresentarem estenose retal 16 ou outras malformações no cérebro 35 , abdomen e até mesmo a presença de fenda palatina 16 na cavidade oral do neonato.…”

The immediate and long-term effects of prenatal opioid exposure

“…The absolute risk for severe NAS (need for pharmacologic treatment) was highest in infants co-exposed to opioids and gabapentin. Conversely, some studies showed that the risk of NAS was not affected by other psychotropic medications ( 23 – 25 ). It is unclear if drug-drug interactions or other factors (e.g., socioeconomic, maternal stressors, other medical or psychiatric disorders) contribute to the severity of withdrawal in infants with polysubstance exposure.…”