{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T18:51:49Z","timestamp":1784659909270,"version":"3.55.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2024,9,1]]},"abstract":"Importance<\/jats:title>Children exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n\u2009=\u20095946) and intrauterine exposure to drugs of addiction (n\u2009=\u20091260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n\u2009=\u2009202\u202f098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n\u2009=\u20091\u202f611\u202f351). Data were analyzed from July 2001 to December 2021.<\/jats:p><\/jats:sec>Main Outcomes<\/jats:title>Main outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care.<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 1\u202f820\u202f655 live births, 935\u202f807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1\u2009=\u2009A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90\u202f433\/209\u202f304 [43.4%] vs 616\u202f425\/1\u202f611\u202f351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health\/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02.<\/jats:p><\/jats:sec>Conclusion and Relevance<\/jats:title>Children who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.2281","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T15:01:02Z","timestamp":1721660462000},"page":"888","source":"Crossref","is-referenced-by-count":12,"title":["Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood"],"prefix":"10.1001","volume":"178","author":[{"given":"Evelyn","family":"Lee","sequence":"first","affiliation":[{"name":"Centre for Social Research in Health, University of New South Wales, Kensington, New South Wales, Australia"},{"name":"Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, North Ryde, New South Wales, 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Medicine, University of New South Wales, Australia"},{"name":"Department of Paediatrics, Sydney Children\u2019s Hospital, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucinda","family":"Burns","sequence":"additional","affiliation":[{"name":"National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Bajuk","sequence":"additional","affiliation":[{"name":"Critical Care Program, Sydney Children\u2019s Hospitals Network, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Page","sequence":"additional","affiliation":[{"name":"Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Gu","sequence":"additional","affiliation":[{"name":"Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Eastwood","sequence":"additional","affiliation":[{"name":"National Public Health Service, Te Whatu Ora \u2013 Health New Zealand, Dunedin, New Zealand"},{"name":"School of Population Health, University of New South Wales, Kensington, New South Wales, Australia"},{"name":"Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand"},{"name":"Sydney Institute for Women Children and their Families, Sydney Local Health District, Sydney, New South Wales, Australia"},{"name":"Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Dickson","sequence":"additional","affiliation":[{"name":"The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Green","sequence":"additional","affiliation":[{"name":"Alpha Maxx Healthcare, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Dicair","sequence":"additional","affiliation":[{"name":"Private Practice, Havertown, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Lee","family":"Oei","sequence":"additional","affiliation":[{"name":"Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Australia"},{"name":"Department of Newborn Care, Royal 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