Date of Graduation


Document Type


Degree Type



School of Public Health



Committee Chair

Peter R Giacobbi

Committee Co-Chair

Ilana R A Chertok

Committee Member

Lesley E Cottrell

Committee Member

Laura R Lander

Committee Member

D Leann Long

Committee Member

Panitan Yossuck


This dissertation examined neonatal abstinence syndrome (NAS) in West Virginia (WV). Specifically, three studies were conducted that investigated state and regional trends, risks related to NAS, and effectiveness of in utero exposure detection. The first study described regional incidence rates, trends of antenatal drug class-specific exposures, and NAS diagnoses in WV between 2007 and 2013. The findings indicated a 4-fold increase in WV statewide incidence rates of NAS during this time period, which was three times the national annual average. The second study identified the risk of NAS, risk of NAS requiring pharmacologic treatment, and odds of NAS controlling for potential confounders among substance-using pregnant women who gave birth at Ruby Memorial Hospital between January 1st 2009 and March 3rd 2014. Results indicated that multiple substances could lead to a NAS diagnosis and that variations existed between drug class-specific exposure and heightened risk of NAS and NAS requiring pharmacological treatment. The third study assessed the effectiveness of maternal urine drug screens, maternal substance use ICD-9-CM diagnostic codes, and neonatal ICD-9-CM exposure codes in detecting antenatal substance use among a subpopulation from the second study. These alternative methods performed poorly, with low sensitivity values, when compared to a meconium analysis (i.e., a neonatal non-invasive biological drug screen). Therefore, solely utilizing alternative screening methods taken at labor and delivery would likely underestimate the number of exposed newborns. This is important because unidentified newborns could be released from the hospital prior to their withdrawal symptom onset and/or left medically untreated. Taken together, these findings provide both research and clinically relevant implications regarding trends of NAS in WV, drug class-specific risk of NAS and NAS requiring pharmacological treatment, and the effectiveness of in utero exposure detection.