Screening for substance use in pregnancy and the newborn

Polak, Kathryn; Kelpin, Sydney S.; Terplan, Mishka

doi:10.1016/j.siny.2019.01.007

Cited by 17 publications

(11 citation statements)

References 33 publications

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“…34 Although a positive prenatal screen for substance use ideally results in follow-up and connection to support, it may also lead to further toxicology testing, which has more serious legal consequences, especially at the time of delivery. 27,35 There is evidence that providers respond differently to positive toxicology results by race and that protocols standardizing substance use testing may not reduce these disparities. 19,34,36 Clinical implementation efforts around universal prenatal substance use screening can benefit from a better understanding of the repercussions of screening approaches on outcomes and the roles that policies, systems, and provider biases play in perpetuating these approaches.…”

Section: Discussionmentioning

confidence: 99%

“…37 Better understanding the relationship between these policies and racial and economic inequities in maternal health and outcomes can foster action to address these disparities. Finally, it is important to assess how the differential odds of screening receipt based on individual-level characteristics revealed through this study affect subsequent outcomes, like the chasm in maternal mortality between Black and White individuals, 38 rates of follow-up toxicology testing, which may have more serious legal ramifications, 9,35 or increased connection to treatment, which may result in improved maternal and newborn health outcomes. 6…”

Section: Research Implicationsmentioning

confidence: 99%

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Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016–2018

Patel¹,

Bandara²,

Saloner³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Section: Research Implicationsmentioning

confidence: 99%

Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016–2018

Patel¹,

Bandara²,

Saloner³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the third trimester pregnancy, mothers retrospectively reported their substance use just before finding out they were pregnant and shortly thereafter, which also may have introduced inaccurate reporting. Previous research has shown up to 97% concordance between women's self-reported substance use during pregnancy and biological samples (Hutchinson et al, 2018), although most research and clinical practice supports the use of self-report screening in conjunction with biological measures for optimal substance use identification during pregnancy (Burns, Gray, & Smith, 2010; Polak, Kelpin, & Terplan, 2019). Perinatal data were collected for pregnancies identified in women aged between 29 and 35 years, the peak period for births in high-income countries such as Australia.…”

Section: Discussionmentioning

confidence: 99%

Continuities in maternal substance use from early adolescence to parenthood: findings from the intergenerational cohort consortium

et al. 2021

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Background This study assessed the extent to which women's preconception binge drinking, tobacco use and cannabis use, reported prospectively in adolescence and young adulthood, predicted use of these substances during pregnancy and at 1 year postpartum. Methods Data were pooled from two intergenerational cohort studies: the Australian Temperament Project Generation 3 Study (395 mothers, 691 pregnancies) and the Victorian Intergenerational Health Cohort Study (398 mothers, 609 pregnancies). Alcohol, tobacco and cannabis use were assessed in adolescence (13–18 years), young adulthood (19–29 years) and at ages 29–35 years for those transitioning to parenthood. Exposures were weekly or more frequent preconception binge drinking (5 + drinks in one session), tobacco use and cannabis use. Outcomes were any alcohol, tobacco and cannabis use prior to awareness of the pregnancy, after awareness of pregnancy (up to and including the third trimester pregnancy) and at 1 year postpartum. Results Frequent preconception binge drinking, tobacco use and cannabis use across both adolescence and young adulthood were strong predictors of continued use post-conception, before and after awareness of the pregnancy and at 1 year postpartum. Substance use limited to young adulthood also predicted continued use post-conception. Conclusions Persistent alcohol, tobacco use and cannabis use that starts in adolescence has a strong continuity into parenthood. Reducing substance use in the perinatal period requires action well before pregnancy, commencing in adolescence and continuing into the years before conception and throughout the perinatal period.

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“…40e42 Finally, urine toxicology testing or other maternal biological assays should be used with caution and not as a replacement for voluntary screening using a standardized tool. 31,43 If urine toxicology testing is used, it is the responsibility of the obstetrical provider to be knowledgeable about screening vs confirmatory testing and how the results will inform care. As obstetrical providers, we are direct care providers, leaders in our healthcare systems, and advocates for public policy.…”

Section: Solutionmentioning

confidence: 99%

Early lessons from maternal mortality review committees on drug-related deaths—time for obstetrical providers to take the lead in addressing addiction

Smid

Schauberger

Terplan

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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Understanding the Problem The United States is in the midst of a fatal drug crisis among pregnant and postpartum women-over the past 2 decades, the rates of opioid use disorder (OUD) have quadrupled. 1 Among reproductive-age women, drug-related death-death from poisoning caused by legal, illegal, or medically prescribed drugs-has emerged as a leading cause of death; however, less is understood about the circumstances and preventability of these deaths in pregnant and postpartum women. 2 Maternal mortality review committees (MMRCs) are 1 of 3 national surveillance mechanisms for maternal death in the United States. 3 Because the National Vital Statistics System and the Pregnancy Mortality Surveillance System rely primarily on birth and death certificates to capture maternal deaths, MMRCs are uniquely positioned to analyze the root causes of maternal drug-related deaths. As of February 2020, there were 48 MMRCs nationwide (46 states and 2 cities) that provide multidisciplinary reviews of pregnancy-associated and pregnancy-related deaths (Table 1) including identification of contributing factors and recommended solution at the patient, provider, community, facility, and system levels. Multiple MMRCs have recently reported that mental health conditions now account for a significant proportion of pregnancy-associated and pregnancy-related deaths. 1,3,6e8 Although most drug-related deaths have been

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Screening for substance use in pregnancy and the newborn

Cited by 17 publications

References 33 publications

Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016–2018

Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016–2018

Continuities in maternal substance use from early adolescence to parenthood: findings from the intergenerational cohort consortium

Early lessons from maternal mortality review committees on drug-related deaths—time for obstetrical providers to take the lead in addressing addiction

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