Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

Abstract

North America is currently suffering from one of the worst epidemics of illicit drug use in recent history: the opioid crisis. Pregnant women are not immune to the ravages of substance misuse which affects themselves, their pregnancies, and the wider community. The prevalence of drug misuse in pregnancy is not well quantified due to the lack of good validated tests, cooperation between clinicians and scientists developing tests, and consensus as to who should be tested and how results should be used. A wide range of tissues can be tested for drug use, including maternal blood, urine, and hair; neonatal meconium, urine, and hair; and placenta and umbilical cord tissues. Testing methods range from simple spectrophotometry and clinical chemistry to sophisticated analytical HPLC or mass spectrometry techniques. The drive for ever greater accuracy and sensitivity must be balanced with the necessities of medical practice requiring minimally invasive sampling, rapid turnaround, and techniques that can be realistically utilized in a clinical laboratory. Better screening tests have great potential to improve neonatal and maternal medical outcomes by enhancing the speed and accuracy of diagnosis. They also have great promise for public health monitoring, policy development, and resource allocation. However, women can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. Balancing the scientific, medical, public health, legal, and ethical aspects of screening tests for drugs in pregnancy is critical for helping to address this crisis at all levels.

International Perspectives on the Implications of Cannabis Legalization: A Systematic Review & Thematic Analysis

“…However, there were no changes in the prevalence of low birth weight or small for gestational age births during this same interval [38]. Despite these findings, the risks of prenatal cannabis exposure should be neither overstated nor minimized, and that the legal status of a substance should not be equated with safety [39]. Scientifically accurate dissemination of cannabis outcomes data is necessary [40], and clinicians must recognize that even in environments where cannabis is legal, pregnant women may end up involved with children’s protective services [41].…”

Role of Neonatal Biomarkers of Exposure to Psychoactive Substances to Identify Maternal Socio-Demographic Determinants

“…The clinical presentation of the disease is inconsistent, some lacking evidence of central nervous system neurodevelopment abnormalities. Typically, for the definite diagnosis of FASD, the confirmation of prenatal ethanol exposure is needed, because some of the characteristics of the disease, in particular, physical, may be absent [ 22 , 53 , 54 ].…”

“…Additionally, the ethical principal of “respect for persons” mandates that the woman give consent for the procedure given the social and legal ramifications of the test. Women also fear stigmatization and the legal consequences of drug use in pregnancy [ 22 ]. This leaves to individual institutions the decision to establish appropriate psychoactive substance testing policies.…”

Assessing the relationship between neonatal abstinence syndrome and birth defects in Delaware

“…The timing of opioid exposure, the type of opioids, the dose (i.e., quantity) are important to assess the levels of opioid exposure during organogenesis (i.e., phase of embryonic development) and/or later in the pregnancy. The current tests to detect fetal exposure to licit and illicit drugs include: radioimmunoassay and enzyme immunoassay tests (i.e., drug screens), urine toxicology, and meconium and umbilical cord analyses (Jones et al, 2015; Price, Collier, & Wright, 2018) and as such, these drug screens test for exposure late in pregnancy.…”