The long term objective is to analyze the impact on neonatal costs of illicit substance abuse among pregnant women who deliver within the New York City municipal hospital system and to develop the data bases necessary to monitor evolving clinical and financial consequences of the current epidemic in prenatal substance abuse. The study has three principal aims. First, to obtain by type of drug, unbiased estimates of the marginal costs of neonatal care for babies of substance abusing mothers. Second, to characterize by type of drug, the mechanisms by which substance abuse exerts its effects on neonatal outcomes. And third, to analyze how the relationships between substance abuse, birth outcomes, and neonatal costs have changed over the three-year period from 1988 through 1990. To this end we shall use a retrospective cohort study based on obstetrical and neonatal discharge records from the eleven acute care facilities administered by the New York City Health and Hospitals Corporation (NYCHHC) that will be linked to vital statistics records from the New York City Department of Health (NYCDOH). The NYCHHC data provide specific cost information as well as a reliable ICD-9 classification for substance abuse based upon either maternal self-report or a positive urine toxicology screen. In 1988, NYCHHC recorded over 2,300 obstetrical discharges with a secondary diagnosis of substance abuse. The NYCDOH data from the recently revised New York City birth certificate contain a variety of maternal demographic characteristics as well as a separate illicit drug use indicator which can be cross-checked with the NYCHHC classification. Unexposed women/offspring pairs recruited from the NYCHHC database will be frequency matched to expose subjects on five potentially confounding variables. Multivariate regression techniques will be applied to the combined data set in order to test a series of hypotheses concerning the effects of in utero exposure to illicit drugs on neonatal clinical and cost outcomes.
