The impact of an obstetric substance use screening and biologic testing protocol on neonatal drug testing.

OBJECTIVE: Substance use during pregnancy may affect fetal development and have implications for newborn, childhood, and life-long health. While standardized maternal screening protocols may reduce testing disparities, there are limited data describing the effects of standardized drug screening protocols on neonatal outcomes. STUDY DESIGN: We conducted a retrospective cohort study of deliveries at a tertiary care center during pre-(7/1/2020-6/9/2021) and post-intervention(6/10/2021-5/31/2022) periods around implementation of a standardized obstetric substance use screening/testing protocol. Associations between neonatal testing and maternal race, ethnicity, and insurance status were assessed using generalized estimating equations (SAS 9.4,α = 0.05). RESULT: Among 3163 pre-intervention and 3389 post-intervention neonates, testing decreased post-intervention (4.5% vs. 6.2%, p = 0.0035), though a higher proportion lacked corresponding maternal tests (70.8% vs. 32.3%, p < 0.001). Black neonates had higher testing odds, which attenuated after adjusting for insurance status. CONCLUSION: Use of a maternal screening protocol was associated with a reduction in neonatal testing, but disparities persist, warranting further study.

Duke Scholars

Author Sarahn M Wheeler Obstetrics and Gynecology, Maternal Fetal Medicine