Drug use during pregnancy can have implications for maternal and fetal morbidity and mortality as well as legal ramifications for patients. The American College of Obstetricians and Gynecologists guideline's state drug screening policies during pregnancy should be applied equally to all people and note that biological screening is not necessary, stating that verbal screening is adequate. Despite this guidance, institutions do not consistently implement urine drug screening policies that reduce biased testing and mitigate legal risk to the patient.
To evaluate the effects of a standardized urine drug testing policy on Labor and Delivery on the number of drug tests sent, self-reported racial makeup of those tested, provider-reported testing indications and neonatal outcomes.
This was a retrospective cohort study. A urine drug screening and testing policy was instituted in December 2019. The electronic medical record was queried for the number of urine drug tests sent on patients admitted to Labor and Delivery from 1/1/2019- 4/30/2019 and compared to the number sent between 1/1/2020-4/30/2020. The primary outcome was the proportion of urine drug tests sent by race before and after policy implementation. Secondary outcomes included total number of drug tests, Finnegan scores (a proxy for Neonatal Abstinence Syndrome), and testing indications. We administered pre- and post-intervention provider surveys to understand perceived testing indications. Chi-square and Fisher exact tests were used to compare categorical variables. Wilcoxon rank-sum test was used to compare nonparametric data. Student's T-test and One-way analysis of variance were used to compare means. Multivariable logistic regression was used to create an adjusted model that included covariates.
In 2019, Black patients were more likely to undergo urine drug testing as compared to White patients, even after adjusting for insurance status (aOR 3.4, CI 1.55-7.32). In 2020, there was no difference in testing by race after adjusting for insurance status (aOR 1.3, CI 0.55-2.95). There was a reduction in the number of drug tests sent between January to April 2019 compared to January to April 2020 (137 vs 71, p<0.001). This was not accompanied by a statistically significant change in incidence of neonatal abstinence syndrome measured by mean Finnegan scores (p=0.4). Prior to implementation, 68% of providers requested patient consent for testing; after implementation, 93% requested consent (p=0.002).
The implementation of a urine drug testing policy improved consent and reduced disparities in testing by race as well as the overall rate of drug testing without impacting neonatal outcomes.
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Accepted: February 27, 2023
Received in revised form: January 31, 2023
Received: November 21, 2022
Publication stageIn Press Accepted Manuscript
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