Disparities in Child Protective Services Reporting Among Pregnant Patients With Positive Urine Drug Screening at Delivery Hospitalization [ID 2683555

Abstract

INTRODUCTION: This study assesses predictors of Child Protective Services (CPS) reporting among patients with a positive urine drug screening (UDS) during delivery hospitalization. METHODS: Patients receiving prenatal care and delivering at any UCHealth location between 2015 and 2022 with a positive UDS at delivery were included. Patient demographics, medical history, UDS, infant toxicology, and CPS reporting were collected from medical records. T-tests or nonparametric equivalents for continuous variables and χ2 or Fisher's exact tests for categorical variables were used to compare patients with and without CPS reporting. RESULTS: We found 523 patients with a positive UDS during their delivery hospitalization, with CPS reporting for 71%. CPS reporting was more common in younger patients (26 versus 28 years; P<.01), patients with prior CPS involvement (15% versus 5%; P<.01), patients with an antenatal UDS positive for any substance (46% versus 29%; P<.01), and any positive neonatal toxicology (87% versus 58%; P<.01). Patients positive for cannabis (78% versus 57%; P<.01) or amphetamines (6% versus 1%; P=.03) were more likely to be reported to CPS, while patients positive for barbiturates (12% versus 1%; P<.01) and benzodiazepines (6% versus 2%; P<.01) were less likely. Hospitals located in large (>400k pop.) or small cities (<100k pop.) were less likely to be reported to CPS than mid-sized cities (>100–399k pop.) (66% and 65% versus 76%; P=.03). CONCLUSION: Differences in CPS reporting depended on the substance that tested positive, infant positivity, and delivery location. Future research should explore reasons for no CPS reporting among patients with a positive UDS during delivery hospitalization.