Master's Project Title:

The Association of Medicaid Funding and Neonate Diagnosis Reflecting Maternal Substance Use in Iowa, 2013

MCH Student:

Zachary Holmquist

Date of Defense:

July 2, 2015


Objective: To describe infants born during 2013 who  were diagnosed with Neonatal Abstinence  Syndrome (NAS) in the state of Iowa. We hypothesized that prenatal maternal characteristics, conditions,  and behavior associated with NAS will differ by Medicaid – funded birth status.

Study Design: Analysis of this descriptive cross – sectional study was conducted on a linked dataset comprised of inpatient hospital discharge records and birth certificate data for Iowa, 2013. Univariate and  multivariate logistic regressions were employed to produce odds ratios (ORs) and 9 5% confidence  intervals to describe the association of Medicaid – funded birth status and NAS outcome.

Results: The crude prevalence of NAS in Iowa was 33.6 cases per 10,000 live births. Stratified by  Medicaid status, Medicaid – funded births had a prevalence  of 60.4 NAS cases per 10,000 live births, with  a non – Medicaid prevalence of 14.6 per 10,000 live births. Mothers of newborns with NAS were more  likely to be under age 18, unmarried, and to have smoked during pregnancy. Before adjustment, the crude  model yielded an odds ratio of 3.95 (2.61, 5.96). The addition of maternal demographic, BMI, and  smoking variables attenuated the adj. OR, which was no longer statistically significant (adj. OR=1.64  (95% CI: 0.98, 2.74)). Only maternal BMI at delivery and maternal smoking status were still significantly  associated with prevalent NAS in the final model.

Conclusion: The prevalence of NAS among Iowan newborns in 2013 does not differ by Medicaid – funded  birth status after accounting for maternal demographics, behaviors , and conditions. Surveillance of  maternal underweight and smoking during pregnancy may better predict prenatal drug use than Medicaid  status.