The Effect of Urine Drug Screening for No Prenatal Care on the Parent–Neonatal Dyad [ID 2683382

Abstract

INTRODUCTION: Urine drug screens (UDS) during pregnancy can perpetuate racial disparities that extend far past medical outcomes and into the autonomy of birthing persons and their family unit. METHODS: This retrospective cohort study compared pregnant patients admitted to the labor floor from September 1, 2020 to June 1, 2022, with UDS collected for no prenatal care (“NPNC”) to those collected for all other indications including altered mental status, use of nonprescribed substances, medications for opioid use disorder, suspicion of abruption, unexplained hypertension, or fetal demise (“Other Cohort”). Chi-squared analysis and Student's t-test were used for statistical analyses. RESULTS: Of 7,022 births, 127 (2%) had UDS collected. Patients who identified as Black were significantly more likely to have UDS collected (P<.0001). Of 127 UDS, 29 were sent for NPNC alone, and 98 were sent for other indications. There was no difference in age, race, or insurance status between the two groups. Among the NPNC cohort, 8 were positive for marijuana alone (28%), 3 (10%) for opioids (two provided by the care team), 1 for benzodiazepine (provided by the care team), and the rest were negative (59%). Significantly more patients were positive for opioids or other substances (not marijuana alone) in the “other cohort” compared to the NPNC cohort (P=.002). CONCLUSION: The majority of UDS for NPNC were negative, or positive for marijuana alone. Our findings show potential for harm, and no added utility, when using NPNC as an indication for collecting a UDS as reporting marijuana alone to government agencies may have disproportionately negative effects for Black patients.