Original ArticleUniversal Maternal Drug Testing in a High-Prevalence Region of Prescription Opiate Abuse
Section snippets
Methods
We conducted a retrospective cohort study from May 2012 through November 2013 at Mercy Anderson Hospital, a community hospital in southwestern Ohio that serves the eastern Cincinnati metropolitan area. During the study period, the hospital cared for 2995 mothers for delivery of 2979 infants (with 38 intrauterine fetal deaths and 22 multiple births), of whom 95% were Caucasian, 52% were married, and 53% had private insurance. Hospital mother-infant services, including a level II nursery and
Results
During the study period (May 2012 through November 2013), there were 2995 maternal admissions. Hospital staff obtained 2956 urine drug tests; 38 tests were not done owing to precipitous delivery, emergent cesarean delivery, or inadvertent omission. One uninsured mother refused to provide a urine specimen for financial reasons. Among the 2956 specimens were 159 positive results, corresponding to 5.4% of the mothers. Of these 159 positive tests, 96 (60%) were positive for opioids, representing
Discussion
With the implementation of universal maternal drug testing, we identified 19 opioid-exposed infants who would have been missed with our previous screening approach. Owing to our standard of care of observing opioid-exposed infants for 72-96 hours, these 19 infants were prevented from premature discharge and possibly poor outcomes.8 We initiated Finnegan scoring earlier for infants with a positive maternal opioid drug test, and initiated the nonpharmacologic treatment bundle in affected infants.
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Substance Use in Pregnancy and Its Impact on Communities of Color
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2023, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingSupporting mother-infant dyads impacted by prenatal substance exposure
2021, Children and Youth Services ReviewCitation Excerpt :Universal maternal toxicology testing with informed consent at delivery has been proposed (Patrick et al., 2020). In a recent single-center cohort study, implementation of a universal testing protocol in a community hospital setting yielded positive toxicology test results among 5.4% of laboring mothers (Wexelblatt et al., 2015). While universal testing may ensure equity and increase identification (thereby facilitating connection to needed services), obvious cost, privacy/confidentiality, and bias (unfair, over-referral of certain sub-populations to child welfare) concerns exist (Chasnoff, Ladress, & Barrett, 1990; Roberts & Nuru-Jeter, 2012).
Concordance and discordance between maternal and newborn drug test results
2021, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :The American College of Obstetricians and Gynecologists does not recommend laboratory testing, in large part owing to the potential legal and ethical pitfalls.5,6 However, many practitioners continue to rely on urine drug testing of the mother, newborn, or both in place of validated questionnaires, often citing concerns regarding underreporting and potential late recognition of neonatal withdrawal.7–13 Despite widespread use, laboratory testing has shortcomings.
The authors declare no conflicts of interest.