Abstract
IntroductionThe objective was to determine if pregnant women visiting the emergency department (ED) are tested for substance use as frequently as non-pregnant women.MethodsWe captured all ED visits over a six-year period (2010–2016) from a single community hospital and identified women of childbearing age, defined for our study as 11–50 years old. We collected demographic data including age in years, ethnicity, body mass index, marital status, disposition, last encounter department, method of arrival, and day of week. An independent binary variable was created based on whether the woman was tested for alcohol or drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, opioids) during her visit. We then compared rates of testing for substance use by pregnancy status.ResultsWe identified 61,222 ED visits by women of childbearing age (range 11–50, mean 30.5, standard deviation 9.6) over a six-year period from 2010–2016. Of the 57,360 non-pregnant women, 4.14% were tested compared to 1.04% of the 3,862 pregnant women tested with a relative risk of 0.25 (p<0.001, 95% confidence interval [CI] [0.183–0.341]). The most highly tested chief complaints for all women – psychiatric or substance use concerns – showed pregnant women were still 37% and 54% less likely to be tested, respectively (risk ratio [RR] 0.46, 95% CI [0.19–1.13]; RR 0.63, 95% CI [0.41–0.96]). Beyond pregnancy status, we found no significant interaction between patient demographics and substance use testing.ConclusionPregnant women presenting to the ED were 75% less likely to be tested for drug or alcohol use than non-pregnant women. Our study showed only pregnancy status as a statistically significant variable in drug- and alcohol-screening rates when pregnant and non-pregnant patient chief complaints and demographics were compared. Increased attention to the screening of pregnant women for substance use may be necessary to provide adequate care and intervention to this population.
Highlights
IntroductionSubstance Use in Pregnant Women Using the emergency department (ED) mortality among birth mothers of children diagnosed with an Fetal alcohol spectrum disorder (FASD) is increased by nearly 39-fold.[2,5,6] Recent data demonstrate that 11.9% of non-pregnant women and 5.3% of pregnant women age 15-44 reported illicit drug use in November, 2016.1 Alcohol use at levels meeting criteria for binge or heavy drinking was reported by 23.7% of nonpregnant women and 2.8% of pregnant women.[1]
The objective was to determine if pregnant women visiting the emergency department (ED) are tested for substance use as frequently as non-pregnant women
Of the 57,360 non-pregnant women, 4.14% were tested compared to 1.04% of the 3,862 pregnant women tested with a relative risk of 0.25 (p
Summary
Substance Use in Pregnant Women Using the ED mortality among birth mothers of children diagnosed with an FASD is increased by nearly 39-fold.[2,5,6] Recent data demonstrate that 11.9% of non-pregnant women and 5.3% of pregnant women age 15-44 reported illicit drug use in November, 2016.1 Alcohol use at levels meeting criteria for binge or heavy drinking was reported by 23.7% of nonpregnant women and 2.8% of pregnant women.[1]. According to the National Institute on Drug Abuse, of the more than 130 million visits to emergency departments (ED) in 2009, 2.1 million (2.73%) were for drug abuse.[7] From 2004 to 2009 ED visits for non-medical use of drugs increased 98% (nearly 20% per year), with 32% of patients reporting concurrent alcohol use.[7] In 2005 the National Alcohol Survey found that 24% of individuals presenting to the ED reported high-risk drinking behaviors.[8,9]
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