Cannabis Use in Pregnancy: Effects of a Hospital Policy on Toxicology Screening Practices [ID: 1377573]

Abstract

INTRODUCTION:Guidelines for toxicology screening in pregnancy are lacking. Studies suggest provider bias in implementation and potential serious consequences for patients. We examined the effect of a novel hospital policy.METHODS:A protocol was outlined for verbal screening, counseling, and toxicology screening by a hospital task force on cannabis use in pregnancy. Institutional review board approval was obtained for study. A retrospective chart review and analysis of practices on admission for delivery was performed 6 months pre- and post-policy implementation in resident low-risk and maternal–fetal medicine clinics.RESULTS:There were 2,373 deliveries during the study period and 129 mother–infant dyads underwent toxicology screening. The rate of maternal screening did not significantly differ pre- and post-policy implementation (2.6% versus 3.4%, P=.23). In those screened, the rate of maternal cannabinoid positivity increased significantly post-policy (13.8–42.9%, P=.005). Similarly, the rate of neonatal screening did not significantly differ pre- and post-policy implementation (3.4% versus 3.6%, P=.88), while the neonatal cannabinoid positivity rate increased significantly post-policy (7.7–31.8%, P=.005). There were no significant differences in demographics of those screened pre- versus post-policy.CONCLUSION:Implementing a hospital policy did not change the rate or demographics of screening but did correlate with an increased cannabinoid detection rate. The effects of the policy should be cautiously considered. The benefit of standardized verbal screening and discussion of risks is clear, but potential harm from toxicology screening remains.