When Is Illicit Drug Screening Indicated in Pregnant Women on Labor and Delivery in Colorado? [3Q

Abstract

INTRODUCTION: Women on labor and delivery undergo illicit drug screening for various indications many of which may not be appropriate indicators of use. We investigated which indications are associated with positive testing. METHODS: We performed a historical cohort study of all pregnant women with positive drug screens on labor and delivery at a safety-net hospital in Denver, Colorado between 2010-2014. Testing was performed at provider discretion based on concern for substance use and patients were consented. Illicit drugs are included; tetrahydrocannabinol is not. Chart abstraction included testing indications, demographic, reproductive, social, and substance use characteristics. Descriptive statistics were computed. RESULTS: Between 2010-2014, there were 121 positive urine toxicology screens. Most women in our cohort were ≤30 years old (70.2%), white (81%), not Hispanic (55.4%), single (54.5%), and unemployed (90.9%). Obstetrical indications for testing: preterm labor (24.0%), placental abruption (14.0%), abnormal maternal behavior (11.6%), intrauterine fetal demise (6.6%), abnormal maternal vital signs (5.8%), outborn delivery (6.6%), precipitous delivery (3.3%), trauma (5.0%), pain (3.3%), and abnormal fetal monitoring (0%). Social indications for testing and frequencies of a positive test were: self-reported illicit drug use (61.2%), documented historical use (9.1%), no prenatal care (21.5%), and scant prenatal care (5.0%). 77% of positive tests had at least one social indication for testing. CONCLUSION: Over three-fourths of positive tests were performed based on social factors elicited from patient histories. While obstetric indications did provide some positive tests, emphasizing excellent history taking may optimize illicit drug testing strategies.