(565) Association between neonatal abstinence syndrome and access to obstetric delivery facilities

A growing number of counties lack access to delivery facilities offering obstetric care (OBC) due to increasing rates of hospital closures across the country. Rates of neonatal abstinence syndrome (NAS) are often higher in counties with less access to maternal and substance use services. We sought to evaluate the association between diagnosis of NAS and access to a delivering facility with OBC.

Study Design: A retrospective chart review involving opiate-exposed maternal-infant dyads who delivered at our safety net hospital from January 2015 to December 2022 was conducted. County of residence, use of prescribed and non-prescribed substances, and neonatal outcomes were collected. March of Dimes classifications for access to delivery facilities were applied by county (delineated as full, moderate, low, or no access). The primary outcome was a diagnosis of NAS as compared to OBC access in primary county of residence.

Results:

A total of 1301 dyads with substance exposure were identified and stratified by access to a delivery facility with OBC (n= 575 (44.2%) resided in no; n=290 (22.3%) in low; and n=436 (33.5%) in moderate). Of note, none of the dyads included had full access to delivery facilities. Of the neonates, 93% displayed NAS symptoms and 7% did not. Multivariate regression was then performed on outcome variables including LOS, need for pharmacologic therapy, and NAS symptoms using no access as the base. Moderate access was associated with decreased odds of needing pharmacologic therapy (OR 0.588, SE 0.082, p< 0.01) and NAS (OR 0.549, SE 0.13, p< 0.05) when compared to no access.

Conclusion: Low or no access to delivery facilities was associated with increased odds of NAS and need for neonatal pharmacologic therapy. This finding continues to demonstrate the importance of increasing access to maternal, substance use, and mental health services for improvement of both maternal and neonatal outcomes. Further studies should investigate why residing in a county with moderate access to delivery facility with OBC improved neonatal outcomes in this population.