Urine drug screens for drug abuse in pregnancy: Problems and pitfalls

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U se of illicit substances is common in the United States. According to the National Institute of Drug Abuse, 70% to 90% of Americans 15-40 years of age have used mood-altering chemicals, and approximately half of these are women of reproductive age.1 Cocaine use in particular has increased dramatically, with a recent estimate that 20 million Americans have tried the drug at least once and that 4-6 million use it regularly. Drug use has escalated in all age groups, with the largest increase in those 12-25 years of age. The National Institute of Drug Abuse has also estimated that the frequency of cocaine use in pregnant women approaches 10%, with the rate significantly higher in urban areas such as New York City and Boston. Substantial adverse perinatal outcomes, including prematurity, low birth weight, abruptio placenta, congenital malformation, and fetal death, are reported to be associated with cocaine and other illicit substances. 2-5 Clearly, in addition to exposure to illicit psychoactive substances, multiple other factors are involved with increased risk for problems of growth and development in these children. 6 These include the concomitant use of tobacco and alcohol, poverty, nutritional deficits, a lack of nurturing and supportive parenting, and a lack of adequate medical care. Investigations conducted at large teaching hospitals report rates of substance abuse to be from 10% to 17% in pregnant women. 7 Drug abuse patterns, however, vary based on geographic locations as well as patient populations. The identification of illicit drug use during pregnancy has escalated in © 1994 by The Jacobs Institute of Women's Health 1049-3867/94/$7.00