Alexandra Van Cleave

Background: Urine drug screening (UDS) is commonly utilized to identify substance use during pregnancy and facilitate timely interventions aimed at mitigating adverse parental and neonatal outcomes. Current literature has demonstrated that UDS among pregnant patients is not uniformly applied across populations but less is known about screening practices among neonates. This study aimed to evaluate the demographics, clinical indications, documentation and disclosure practices, and outcomes associated with neonatal drug screening. Methods: A retrospective chart review was completed for neonates at one academic institution whose birthing parent had undergone UDS. Statistical methods to analyze this data included t-tests, calculated percentages, and chi square analysis to compare whether the independent variables evaluated affected screening decisions. Results: Of 651 neonates of parents who completed a UDS during their pregnancy, 273 (42.5%) screens were positive. Amphetamine (36.8%) and cannabinoid (38.6%) accounted for the majority of positive substances. Neonatal race and ethnicity data showed that the overall racial distribution of neonatal drug screens obtained was proportional to the racial representation in the study’s population. However, the proportion of patients screened in the study does not reflect the proportion of patients within each race and ethnicity found among the birthing population. The majority (97.8%) of drug screens obtained did not include documentation of parental consent. Conclusions: Systemic changes need to be made to ensure equitable screening protocols exist for neonatal drug screens as well as ensure parental consent and knowledge of screening results is documented.

Background: The purpose of this study was to understand the current demographics and characteristics of patients undergoing urine drug screening on labor and delivery units with the intention of using this data to create a more evidence-based, equitable policy to reduce bias in the screening process. Methods: A retrospective chart review was performed of 509 instances of drug screening occurring for pregnant and recently delivered patients across three hospitals in Omaha, Nebraska. Demographics of patients, including age, race, ethnicity, and insurance status, as well as reasons for drug screening, patient consent, screening results, and disclosure of results, were analyzed to assess patterns in screening. Results: 509 screening instances were evaluated with 324 unique patients. While Black patients made up 11.6% of the overall patient population, they accounted for 26.2% of the patients undergoing urine drug screenings. 2.88% of all patients self-identified as Hispanic; however, they comprised 13.4% of all patients screened. Consent was documented in 11.3% of cases and a reason for obtaining UDS was documented in 61.5% of cases. The most common reasons cited were history of substance use or current use, medical indications, and suspected use without documented history of use. Conclusions: Establishment of more specific, evidence-based policies for urine drug screening may reduce the impact of implicit biases on current screening practices and serve as one avenue to rebuild trust with patients who have historically been marginalized by the medical community.