Racial Disparities in Newborn Drug Testing After Implementation of Question-Based Screening for Prenatal Substance Use.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
06 Jun 2024
06 Jun 2024
Historique:
received:
26
12
2023
accepted:
11
04
2024
medline:
6
6
2024
pubmed:
6
6
2024
entrez:
6
6
2024
Statut:
aheadofprint
Résumé
To examine the association of universal question-based screening for prenatal substance use on racial inequities in prenatal and newborn drug testing. We conducted a retrospective cohort study of 32,802 live births of patients receiving prenatal care at an academic medical center in the midwestern United States from 2014 to 2022, before and after implementation of question-based screening in 2018. Primary outcomes included prenatal and newborn drug test orders. Logistic regression models using a generalized estimating equation framework assessed associations with question-based screening and results, birthing parent age, race, ethnicity, marital status, and insurance type. Charts of patients who indicated difficulties stopping substance use were audited for guideline-directed care. A total of 12,725 of 14,992 pregnant people (85.3%) received question-based screening. Implementation of question-based screening was associated with a decrease in prenatal urine test orders (5.0% [95% CI, 4.6-5.3%] before implementation, 3.1% [95% CI, 2.8-3.4%] after implementation; P<.001), with Black birthing parents having the largest reduction in prenatal urine drug testing (10.3% [95% CI, 9.0-11.7%] before implementation, 4.9% [95% CI, 3.9-5.9%] after implementation). However, rates of newborn drug testing did not change (4.7% [95% CI, 4.4-5.0%] before implementation, 4.5% [95% CI, 4.2-4.8%] after implementation; P=.46), and clinicians continued to order significantly more newborn drug tests for newborns of Black birthing parents compared with other race and ethnicity groups. Implementation of question-based screening for substance use in pregnancy was associated with decreased prenatal urine drug testing but no change in overall newborn drug testing or racial inequities in newborn drug testing for Black birthing people. Further policy efforts are warranted to improve substance use treatment and to eliminate racial inequities in punitive policies such as newborn drug testing and subsequent child protective services reporting.
Identifiants
pubmed: 38843536
doi: 10.1097/AOG.0000000000005631
pii: 00006250-990000000-01094
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Financial Disclosure The authors did not report any potential conflicts of interest.
Références
Drake P, Driscoll AK, Mathews TJ. Cigarette smoking during pregnancy: United States, 2016. NCHS Data Brief No. 305. National Center for Health Statistics. Accessed July 15, 2023. https://cdc.gov/nchs/products/databriefs/db305.htm
Ko JY, D'Angelo DV, Haight SC, Morrow B, Cox S, Salvesen von Essen B, et al. Vital signs: prescription opioid pain reliever use during pregnancy—34 U.S. jurisdictions, 2019. MMWR Morb Mortal Wkly Rep 2020;69:897–903. doi: 10.15585/mmwr.mm6928a1
doi: 10.15585/mmwr.mm6928a1
Young-Wolff KC, Ray GT, Alexeeff SE, Adams SR, Does MB, Ansley D, et al. Rates of prenatal cannabis use among pregnant women before and during the COVID-19 pandemic. JAMA 2021;326:1745–7. doi: 10.1001/jama.2021.16328
doi: 10.1001/jama.2021.16328
Substance Abuse and Mental Health Services Administration. 2021 NSDUH detailed tables. Accessed July 15, 2023. https://samhsa.gov/data/report/2021-nsduh-detailed-tables
Gosdin LK, Deputy NP, Kim SY, Dang EP, Denny CH. Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years—United States, 2018–2020. MMWR Morb Mortal Wkly Rep 2022;71:10–3. doi: 10.15585/mmwr.mm7101a2
doi: 10.15585/mmwr.mm7101a2
McCourt AD, White SA, Bandara S, Schall T, Goodman DJ, Patel E, et al. Development and implementation of state and federal child welfare laws related to drug use in pregnancy. Milbank Q 2022;100:1076–120. doi: 10.1111/1468-0009.12591
doi: 10.1111/1468-0009.12591
Chasnoff IJ, Landress HJ, Barrett ME. The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. N Engl J Med 1990;322:1202–6. doi: 10.1056/NEJM199004263221706
doi: 10.1056/NEJM199004263221706
Roberts D. Torn apart. Accessed July 14, 2023. https://hachettebookgroup.com/titles/dorothy-roberts/torn-apart/9781549193170/?lens=basic-books
Carroll JJ, El-Sabawi T, Ostrach B. The harms of punishing substance use during pregnancy. Int J Drug Pol 2021;98:103433. doi: 10.1016/j.drugpo.2021.103433
doi: 10.1016/j.drugpo.2021.103433
Schoneich S, Plegue M, Waidley V, McCabe K, Wu J, Chandanabhumma PP, et al. Incidence of newborn drug testing and variations by birthing parent race and ethnicity before and after recreational cannabis legalization. JAMA Netw Open 2023;6:e232058. doi: 10.1001/jamanetworkopen.2023.2058
doi: 10.1001/jamanetworkopen.2023.2058
Jarlenski M, Shroff J, Terplan M, Roberts SCM, Brown-Podgorski B, Krans EE. Association of race with urine toxicology testing among pregnant patients during labor and delivery. JAMA Health Forum 2023;4:e230441. doi: 10.1001/jamahealthforum.2023.0441
doi: 10.1001/jamahealthforum.2023.0441
Drake B, Jones D, Kim H, Gyourko J, Garcia A, Barth RP, et al. Racial/ethnic differences in child protective services reporting, substantiation and placement, with comparison to non-CPS risks and outcomes: 2005–2019. Child Maltreat 2023;28:683–99. doi: 10.1177/10775595231167320
doi: 10.1177/10775595231167320
Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet 2017;389:1453–63. doi: 10.1016/S0140-6736(17)30569-X
doi: 10.1016/S0140-6736(17)30569-X
Ecker J, Abuhamad A, Hill W, Bailit J, Bateman BT, Berghella V, et al. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. Am J Obstet Gynecol 2019;221:B5–28. doi: 10.1016/j.ajog.2019.03.022
doi: 10.1016/j.ajog.2019.03.022
Kurtz T, Smid MC. Challenges in perinatal drug testing. Obstet Gynecol 2022;140:163–6. doi: 10.1097/AOG.0000000000004808
doi: 10.1097/AOG.0000000000004808
Roberts SCM, Nuru-Jeter A. Universal screening for alcohol and drug use and racial disparities in child protective services reporting. J Behav Health Serv Res 2012;39:3–16. doi: 10.1007/s11414-011-9247-x
doi: 10.1007/s11414-011-9247-x
Michigan Legislature. Michigan public health code MCL 333.7212. Accessed August 21, 2022. http://legislature.mi.gov/doc.aspx?mcl-333-7212
Michigan Department of Health and Human Services. Notification of policy changes (PSB 2018-001). Accessed March 26, 2024. https://michigan.gov/-/media/Project/Websites/mdhhs/Folder2/Folder97/Folder1/Folder197/Section_2222_PA_207_of_2018.pdf?rev=0273223518a84c00a01fee8295815b64
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370:1453–7. doi: 10.1016/S0140-6736(07)61602-X
doi: 10.1016/S0140-6736(07)61602-X
Rioux C, Weedon S, London-Nadeau K, Paré A, Juster RP, Roos LE, et al. Gender-inclusive writing for epidemiological research on pregnancy. J Epidemiol Community Health 2022;76:823–7. doi: 10.1136/jech-2022-219172
doi: 10.1136/jech-2022-219172
Patel E, Bandara S, Saloner B, Stuart EA, Goodman D, Terplan M, et al. Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016-2018. Am J Obstet Gynecol MFM 2021;3:100419. doi: 10.1016/j.ajogmf.2021.100419
doi: 10.1016/j.ajogmf.2021.100419
Peterson JA, Koelper NC, Curley C, Sonalkar SR, James AT. Reduction of racial disparities in urine drug testing after implementation of a standardized testing policy for pregnant patients. Am J Obstet Gynecol MFM 2023;5:100913. doi: 10.1016/j.ajogmf.2023.100913
doi: 10.1016/j.ajogmf.2023.100913
Roberts SC, Zaugg C, Martinez N. Health care provider decision-making around prenatal substance use reporting. Drug Alcohol Depend 2022;237:109514. doi: 10.1016/j.drugalcdep.2022.109514
doi: 10.1016/j.drugalcdep.2022.109514
Substance Abuse and Mental Health Services Administration. Preventing the use of marijuana: focus on women and pregnancy. Substance Abuse and Mental Health Services Administration; 2019.
Armstrong MA, Gonzales Osejo V, Lieberman L, Carpenter DM, Pantoja PM, Escobar GJ. Perinatal substance abuse intervention in obstetric clinics decreases adverse neonatal outcomes. J Perinatol 2003;23:3–9. doi: 10.1038/sj.jp.7210847
doi: 10.1038/sj.jp.7210847
Goler NC, Armstrong MA, Taillac CJ, Osejo VM. Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard. J Perinatol 2008;28:597–603. doi: 10.1038/jp.2008.70
doi: 10.1038/jp.2008.70
Lo JO, Hedges JC, Metz TD. Cannabis use and perinatal health research. JAMA 2023;330:913–4. doi: 10.1001/jama.2023.14697
doi: 10.1001/jama.2023.14697
Metz TD, Allshouse AA, McMillin GA, Greene T, Chung JH, Grobman WA, et al. Cannabis exposure and adverse pregnancy outcomes related to placental function. JAMA 2023;330:2191–9. doi: 10.1001/jama.2023.21146
doi: 10.1001/jama.2023.21146