Perinatal Illicit Drug and Marijuana Use

Abstract

Purpose To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits. Design Observational study that qualitatively assesses provider screening and patient disclosure of substance use. Setting Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania. Participants Pregnant patients and obstetric providers were recruited as participants. Methods We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure. Results Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use. Conclusion Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers. (Am J Health Promot 0000; 00[0]:000–000.)

Characterization of U.S. State Laws Requiring Health Care Provider Reporting of Perinatal Substance Use

“…State laws allowing for involuntary commitment for treatment or custody loss solely because of prenatal substance use violate the principles of patient autonomy and beneficence (American College of Obstetricians and Gynecologists Committee on Ethics, 2015). Punitive measures may discourage women from seeking care or disclosing substance use to their health care providers (Chang et al, 2015; Roberts & Pies, 2011). …”

Protection Versus Progress: The Challenge of Research on Cannabis Use During Pregnancy

“…For example, one study found that only 36% of pregnant patients who tested positive for cannabis disclosed use to providers. 39 Fear of consequences may lead women who are using substances during pregnancy to avoid prenatal care entirely. 40 Indeed, at the state level, more punitive responses to prenatal substance use are associated with an increase in low birth weight and preterm births, suggesting that such policies have the unintended effect of worsening birth outcomes.…”

Patient–Health Care Provider Conversations About Prenatal Genetic Screening

“…11–13 We analyzed audio recordings of first prenatal visits at three urban clinic sites in Pittsburgh, Pennsylvania from 2011 to 2014. Obstetric health care providers at the clinics include obstetrics and gynecology residents, obstetrics and gynecology faculty and midlevel health care providers.…”