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Reduction in Newborns With Discharge Coding of In Utero Alcohol Effects in the United States, 1993 to 2002
James M. Robbins, PhD;
T. M. Bird, MS;
John M. Tilford, PhD;
J. Alex Reading, MS;
Mario A. Cleves, PhD;
Mary E. Aitken, MD, MPH;
Charlotte M. Druschel, MD, MPH;
Charlotte A. Hobbs, MD, PhD
Arch Pediatr Adolesc Med. 2006;160:1224-1231.
Objective To determine whether use of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for fetal alcohol effects has declined during the past 10 years among hospitalized newborns in the United States.
Design Trends in use of the ICD-9-CM code 760.71, "alcohol affecting the fetus," among newborns from 1993 through 2002 were compared with trends in self-reported drinking during pregnancy and maternal diagnoses of alcohol abuse during childbirth.
Setting Sampled short-term, nonfederal general and specialty hospitals.
Participants Infants born from 1993 to 2002 in the United States who were included in the Healthcare Cost and Utilization Project databases.
Main Outcome Measures Documentation of ICD-9-CM code 760.71 among newborns, self-reported drinking during pregnancy, and diagnoses of maternal alcohol abuse during childbirth from 1993 through 2002.
Results The prevalence of the ICD-9-CM code 760.71 for alcohol affecting the fetus, as documented in the discharge record of newborns, declined from 0.73 (95% confidence interval, 0.56-0.92) per 1000 live births in 1993 to 0.17 (95% confidence interval, 0.13-0.20) per 1000 live births in 2002. Rates declined concurrently with those of self-reported alcohol consumption during pregnancy and diagnoses of maternal alcohol abuse during childbirth.
Conclusions Use of the ICD-9-CM code for alcohol affecting the fetus among newborns declined 75% throughout 10 years. Results may be due to decreases in drinking during pregnancy, decreases in disclosure of alcohol use by the mother, or more selective use of the discharge code. National hospital discharge databases may allow cost-effective monitoring of public health interventions that address rare conditions of the fetus and newborn.
Author Affiliations: Arkansas Center for Birth Defects Research and Prevention (Drs Robbins, Tilford, Cleves, and Hobbs), Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock (Drs Robbins, Tilford, Cleves, Aitken, and Hobbs, Mr Bird, and Ms Reading); and Congenital Malformations Registry, New York State Department of Health, New York (Dr Druschel).
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