{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T01:36:23Z","timestamp":1777512983096,"version":"3.51.4"},"reference-count":24,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T00:00:00Z","timestamp":1566432000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Despite the rising incidence of neonatal abstinence syndrome (<jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content>), data evaluating trends in maternal risk factors associated with <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> have not been available for recent years, a period characterized by declining opioid prescriptions. The objective of this study was to examine the prevalence of opioid\u2010 and non\u2013opioid\u2010related factors associated with <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content>, and by mutually exclusive subgroups of deliveries without prescription\u2010opioid use, with prescription\u2010opioid use, and with opioid\u2010use disorder (<jats:styled-content style=\"fixed-case\">OUD<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort of pregnancies resulting in live births in a commercial claims data base in 2011\u20132015 was identified. Examples of maternal risk factors of interest included antepartum prescription\u2010drug use (e.g., opioids, selective serotonin reuptake inhibitors [<jats:styled-content style=\"fixed-case\">SSRI<\/jats:styled-content>s], antipsychotics) and nonprescription\u2010related factors (e.g., smoking, <jats:styled-content style=\"fixed-case\">OUD<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 659 cases of <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> among 621,940 deliveries was identified. Among <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> deliveries, prescription opioids were the most commonly used drug\u2010class (39.0%). Adjusted relative risk (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) for <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> was 5.43 (95% confidence interval [CI] 4.25\u20136.95), followed by <jats:styled-content style=\"fixed-case\">SSRI<\/jats:styled-content>s (20.9%; <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 3.16, CI 2.43\u20134.11); <jats:styled-content style=\"fixed-case\">OUD<\/jats:styled-content> was noted in 36.3% of the deliveries (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 40.74, CI 22.64\u201373.32). In the subgroup of deliveries without a prescription opioid (33% of overall <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> deliveries), the absolute incidence of <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> was low (0.3 cases\/1000 deliveries), and <jats:styled-content style=\"fixed-case\">SSRI<\/jats:styled-content>s were the most commonly used medication class (32.7%; <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 10.21, CI 7.28\u201314.31). In the subgroup of deliveries with an opioid prescription, the absolute incidence of <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> was 7.7\/1000 (29% of all overall <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> deliveries), and 22.7% of these deliveries were exposed to one other psychotropic agent in addition to the opioid, most commonly an <jats:styled-content style=\"fixed-case\">SSRI<\/jats:styled-content> (18.0%). In the subgroup of deliveries with a diagnosis of <jats:styled-content style=\"fixed-case\">OUD<\/jats:styled-content>, the <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> incidence was high (214.3\/1000 [36% of all <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> cases]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A third of <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> deliveries did not have evidence of prescription opioids. Other psychotropic medications, especially <jats:styled-content style=\"fixed-case\">SSRI<\/jats:styled-content>s, were strong predictors of <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> in this stratum but had no relevance among deliveries with <jats:styled-content style=\"fixed-case\">OUD<\/jats:styled-content>, suggesting varying etiologies and the need for tailored preventive approaches to reduce <jats:styled-content style=\"fixed-case\">NAS<\/jats:styled-content> effectively.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2315","type":"journal-article","created":{"date-parts":[[2019,7,30]],"date-time":"2019-07-30T14:44:31Z","timestamp":1564497871000},"page":"1005-1011","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Prevalence of Maternal\u2010Risk Factors Related to Neonatal Abstinence Syndrome in a Commercial Claims Database: 2011\u20102015"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7160-9345","authenticated-orcid":false,"given":"Chintan V.","family":"Dave","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amie","family":"Goodin","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanmin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Almut","family":"Winterstein","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9422-7390","authenticated-orcid":false,"given":"Adel","family":"Alrwisan","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham","family":"Hartzema","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Outcomes and Policy College of Pharmacy University of Florida Gainesville 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