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TDH epidemiologist leads groundbreaking research on impact of NAS

Mary-Margaret Fill, M.D.
Mary-Margaret Fill, M.D.

NASHVILLE, Tenn. – The Tennessee Department of Health is leading the nation in surveillance and reporting of Neonatal Abstinence Syndrome, a condition in which a baby has withdrawal symptoms after being exposed in utero to substances such as medications or illicit drugs. Now, a TDH epidemiologist is leading groundbreaking research on the potential long-term impact of NAS on children.

TDH Medical Epidemiologist Mary-Margaret Fill, MD has authored a study to be published in the September issue of Pediatrics. Her study titled “Educational Disabilities among Children Born with Neonatal Abstinence Syndrome” reports findings of the first research of its kind in the United States on whether NAS is associated with educational disabilities.

“In Tennessee, the rate of NAS has increased more than 1,700 percent since 1999. Although some studies have indicated that infants with intrauterine exposure to opioids might be at increased risk for impaired brain development, the measurable impact on these children, their families and society is less well understood,” said Fill.

Fill analyzed data for more than 7,000 Tennessee children between the ages of three and eight, both those born with NAS and those who were not, to learn if those children with a history of NAS required more educational assistance than other children.

Researchers found that children born with NAS were more likely to be referred for evaluation of an educational disability, to meet criteria for an educational disability and to receive special education therapies or services than children without NAS. Developmental delay and speech/language impairment were the most common educational disabilities identified among children with a history of NAS.

“Our findings underscore the importance of continued work to reduce non-essential prenatal drug use and to closely monitor children with a history of NAS in order to diagnose any developmental or educational delays early and promptly begin interventions to help them overcome these disabilities,” Fill said.

TDH Deputy Commissioner for Population Health Michael Warren, MD, MPH, FAAP; Assistant Commissioner of Communicable and Environmental Disease and Emergency Preparedness Tim Jones, MD; Deputy State Epidemiologist John Dunn, DVM, PhD and Epidemiologist Angela Miller, PhD, MSPH served as co-authors of the study. The Tennessee Department of Education and TennCare were integral collaborators on the project, which was funded under a grant to the March of Dimes Foundation from the Centers for Disease Control and Prevention National Center for Birth Defects and Developmental Disabilities and the Office for State, Tribal, Local and Territorial Support. The article is available online at

Tennessee created an NAS Subcabinet working group in 2012 and made Neonatal Abstinence Syndrome a reportable condition in 2013, the first U.S. state to do so. Learn more about NAS at

The mission of the Tennessee Department of Health is to protect, promote and improve the health and prosperity of people in Tennessee.

TDH has facilities in all 95 counties and provides direct services for more than one in five Tennesseans annually as well as indirect services for everyone in the state, including emergency response to health threats, licensure of health professionals, regulation of health care facilities and inspection of food service establishments. Learn more about TDH services and programs at