381: Detection of substance use in pregnant women using the 4Ps questionnaire

Abstract

Professional organizations recommend universal drug screening using a tool such as the “4Ps” ( Pregnancy, Past, Partner, and Parental Use) to identify risk factors for substance abuse. This screening tool has been validated in non-pregnant subjects but not in pregnancy. Our objective was to evaluate the relationship between the “4Ps” screening tool and a concurrent urine drug screen for identification of substance use in pregnancy. This is a prospective cohort study of women receiving prenatal care in a community-based university -affiliated hospital clinic. Patients who were incarcerated, enrolled in a substance use program, under 18 years, non- English/Spanish speaking, intellectually disabled, or unwilling to provide a urine sample were excluded. Consenting subjects completed a de-identified demographic questionnaire, a 4Ps questionnaire, and provided a urine sample at their initial prenatal visit. Urine specimens were analyzed for nine illicit substances using SYVA® EMIT® assays on Beckman Coulter AU 680. One hundred seventy seven women were screened with 4Ps and urine drug screen, of whom 30 (16.9%) had a positive 4Ps screen and 40 (22.6%) had a positive urine drug screen. Four urine drug screens were positive for more than one substance. Marijuana was the most commonly detected substance (n=39), followed by cocaine (3), oxycodone (2), amphetamines (1) and benzodiazepine (1). Test characteristics are depicted in Table 1. The 4Ps questionnaire has low sensitivity and positive predictive value for current substance abuse in pregnancy and is an inadequate screening test. Given the prevalence and perinatal implications of substance use in pregnancy, the development of a validated screening tool is needed.