247 - Maternal Substance Use History and Associated Drug Screen Results

Publication Number: 247.5748

Lauren Ridgway, Phoenix Children's, Phoenix, AZ, United States; Hemananda Muniraman, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States

Background: Substance use during pregnancy has been associated with adverse birth and neonatal outcomes. Screening for substance use disorder in mothers has not been standardized and this screening is often prone to bias. The American College of Obstetrics and Gynecologists (ACOG) recommends screening for substance use disorder in pregnant women to be accomplished by conversations with patients and validated questionnaires. There is a need for ongoing reform of drug screening policies within institutions that prioritize equity and minimize bias.

Objective: This study evaluates the correlation between maternal self-reported substance use history and maternal drug screen results.

Design/Methods: Single center retrospective study of pregnant women admitted 2018-2022 with a positive history of substance use. Data on substances used in current pregnancy were recorded along with results of urine substance testing. The accuracy measures were analyzed by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Area under operative receiver curve.

Results: A total of 1,179 pregnant women were included in this study. The most commonly reported substances by history were Marijuana (40.6%), Tobacco (28.5%), Methamphetamine (24.8%), Methadone (11.7%), and Fentanyl (10%). The majority of substances by history had a high specificity and NPV, however the sensitivities, PPV and AUC varied with the substances. Heroin and Methadone had excellent AUC at 0.97 and 0.91 respectively. Marijuana, Methamphetamines and Fentanyl have fair accuracy measures with AUC at 0.72, 0.73 and 0.71 respectively. For the rest of the substances, history had poor discriminative measures. (Table 1).

Conclusion(s): This retrospective study showed variable accuracy measures for substance use in pregnancy based on history with methadone and heroin having highest AUC. The majority of the substances had very high specificity and negative predictive values suggesting that if maternal history is negative, the urine drug screen is likely to be negative. Further studies are needed to evaluate the utility of laboratory testing in case of negative maternal history.

Table 1 - Maternal Substance Use History and Urine Screen Results