Reconsidering the use of urine drug testing in reproductive settings

Martinez, Noelle G.; Roberts, Sarah C.M.; Achu-Lopes, Rachel A.; Samura, Tirah L.; Seidman, Dominika L.; Woodhams, Elisabeth J.

doi:10.1016/j.ajogmf.2023.101206

American Journal of Obstetrics & Gynecology MFM

2023

DOI: 10.1016/j.ajogmf.2023.101206

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Reconsidering the use of urine drug testing in reproductive settings

Noelle G. Martinez,

Sarah C.M. Roberts,

Rachel A. Achu-Lopes

et al.

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2024

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Cited by 2 publications

References 70 publications

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Evaluating Bias and Racism in a Risk-Factor–Based Drug Testing Policy in the Labor and Delivery Department

Malekmadani,

Puglisi,

Starikov

et al. 2024

O&G Open

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OBJECTIVE: To assess bias in and consent before drug testing during prenatal care and birth in a hospital system with a risk-factor–based drug testing policy. METHODS: This retrospective cohort study included all patients who delivered in a regional hospital system from January 1, 2020, to June 1, 2022. Chart abstraction identified whether urine drug testing was performed and age, race, marital status, insurance status, ZIP code, gestational age, body mass index (BMI), and delivery mode. Propensity score matching through a pregnancy risk model was used to assess the association of race, insurance status, marital status, and median income with likelihood of testing. Data were analyzed with logistic regression. Charts of 200 randomly selected patients were also evaluated for documentation of consent, testing indication, test result, and child welfare reports. RESULTS: Among 20,084 patients, 1,251 (6.2%) were tested, of whom 142 (11.3%) tested positive. White patients had a higher rate of positive test results (16.6%) compared with patients of other racial groups (overall rate 11.3%). None of the patients had consent documented. The most common indication for testing was limited prenatal care (48.7%). Fewer than a third of tests (28.5%) were obtained for a medical indication. The majority (67.9%) of positive results were reported to child welfare services. CONCLUSION: Risk-factor–based toxicology policies disproportionately target Black, low-income, single, publicly insured, and uninsured patients. Patients are typically not consented; testing is infrequently obtained for medical indications; and reports to child welfare services based on positive test results are common.

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Evaluating Bias and Racism in a Risk-Factor–Based Drug Testing Policy in the Labor and Delivery Department

Malekmadani,

Puglisi,

Starikov

et al. 2024

O&G Open

View full text Add to dashboard Cite

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Implementing Best Practice When Screening Birthing People for a Substance Use Disorder

Kaufman,

Suplee,

Campbell‐Oparaji

et al. 2024

J Midwife Womens Health

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Screening for substance use disorder (SUD) is an essential part of antepartum care. Best practice for screening requires the use of a validated tool early in pregnancy to identify those at risk and to connect them with counseling and treatment. In many health systems and practices, urine toxicology testing is erroneously employed as a SUD screening tool despite consistent recommendations against its routine use. The results are often misinterpreted as diagnostic of SUD and can have harmful downstream effects for pregnant and birthing people. This Clinical Rounds reviews the tools available for evidence‐based SUD screenings in pregnancy care, pitfalls of urine toxicology testing, and ways in which midwifery care is well‐positioned to implement evidence‐based screening practices in pregnancy care.

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Reconsidering the use of urine drug testing in reproductive settings

Cited by 2 publications

References 70 publications

Evaluating Bias and Racism in a Risk-Factor–Based Drug Testing Policy in the Labor and Delivery Department

Evaluating Bias and Racism in a Risk-Factor–Based Drug Testing Policy in the Labor and Delivery Department

Implementing Best Practice When Screening Birthing People for a Substance Use Disorder

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