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Drug Testing in Pregnancy

Screening for substance use in all pregnant women is recommended by both the American College of Obstetrics and Gynecology (ACOG) and the American Society of Addiction Medicine (ASAM) in order to provide women and their fetuses and children with the best care during and after pregnancy. In a 2017 joint Opinion, ACOG and ASAM endorsed universal screening for substance use as “a part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman.” Universal screening, rather than selective screening based on risk factors, is recommended to avoid bias and stigma. “Routine screening should rely on validated screening tools, such as questionnaires, including 4Ps, NIDA Quick Screen, and CRAFFT (for women 26 years or younger).”1

Nonetheless, there are ethical considerations even in universal screening. In a recent review in Frontiers in Pharmacology, 3 specialists note, “Better screening tests have great potential to improve neonatal and maternal medical outcomes by enhancing the speed and accuracy of diagnosis…. They also have great promise for public health monitoring, policy development, and resource allocation.” However, they add, “women can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed.”2

1Committee on Obstetric Practice, American Society of Addiction Medicine. Opioid Use and Opioid Use Disorder in Pregnancy. ACOG Committee Opinion Number 711, August 2017. https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Opioid-Use-and-Opioid-Use-Disorder-in-Pregnancy?IsMobileSet=false

2Price HR, Collier AC, Wright TE. Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues. Front Pharmacol 2018; 9: 961. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120972/