Substance Use
Trends in births diagnosed with Neonatal Abstinence Syndrome during the COVID-19 pandemic in the US- A time-series analysis. Alaxandria Crawford* Alaxandria Crawford Courtney Lynch Parvati Singh
Following the onset of the COVID-19 pandemic, data suggest a rise in drug use and overdose mortality in the US. Concurrently, birth rates decreased substantially following the pandemic, with a marked decline in hospital births, in particular. Given the countervailing patterns of drug use (increase) and live births (decline) following the onset of the pandemic, we examined whether infants diagnosed with Neonatal Abstinence Syndrome (NAS) changed during the pandemic. NAS represents a class of conditions observed in neonates exhibiting drug withdrawal symptoms following in utero exposure. We used nationally representative monthly data from the National Inpatient Sample Database (2016 to 2020, 60 months) and tested whether the monthly counts of two outcomes- (1) infants with NAS and (2) pregnant individuals diagnosed with drug use – changed during March to December 2020 (binary exposure indicating COVID-19 pandemic), relative to pre-pandemic period, nationally, as well as across 9 US Census Divisions. We identified diagnoses of NAS and drug use during pregnancy using ICD 10 codes (148,015 NAS births and 3,497,780 pregnant individuals diagnosed with drug use over study period). We used AutoRegressive Integrated Moving Average (ARIMA) time-series analyses to remove seasonality, trends, and autocorrelation in the monthly counts of our outcome series and controlled for monthly volume of total births. Results from ARIMA analyses of national data indicate 151 fewer infants diagnosed with NAS and about 4,300 fewer pregnant individuals diagnosed with drug use in the 10-month span of March-December 2020, relative to prior time period. This decline concentrates in Mid-Atlantic, East North Central, South Atlantic and East South Central US Census Divisions. Our findings provide the first national evidence of decline in the diagnosis of NAS during the COVID-19 pandemic in the US and suggest that drug use among pregnant individuals may have declined following the pandemic onset.
