(998) Understanding predictors of urine toxicology screening to guide equitable screening processes in pregnancy

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Though the rate of positive urine toxicology screens are similar across racial groups, punitive consequences are greater for black patients who test positive. We describe trends and predictors in urine toxicology testing over the last 7 years as awareness increased regarding systemic racism and health care.

Study Design: Retrospective study of all patients delivering at a high volume academic community hospital between 2016 - 2022 to describe number of urine toxicology screens sent from the labor floor. Demographic, clinical, and urine toxicology results were abstracted from the medical record in a 3-year subset of this time period between 1/2019 and 12/2021 and were compared between those who had urine toxicology screening and those who did not. Multivariable logistic regression was performed to adjust for potential confounders.

Results: A total of 659 urine toxicology screens were obtained over the 7-year period with an annual average delivery volume of 6500/year. A downtrend in the number of urine toxicology screens was noted after 2020 (Figure). Between 2019 and 2022, 204 patients had urine toxicology screens and were compared to 18,978 patients who did not. Patients who underwent urine toxicology screening were younger, more likely to be Black, and less likely to have a private physician (Table). After adjustment for confounders, Black race and Hispanic ethnicity were associated with urine toxicology testing (aOR 1.96, 95% CI 1.27 – 3 and aOR 1.56, 95% 1.04 – 2.34, respectively). Among patients who had urine toxicology screening, race, age, parity, care from a private physician, limited prenatal care, lack of prenatal records and obstetrical complications were not predictors of a positive test, but patient-reported drug use in pregnancy was a predictor (p=0.001). Lastly, marijuana was the most commonly reported substance in positive screens (17.7%).

Conclusion: Though urine toxicology screens decreased over the last 7 years, Black and Hispanic race/ethnicity were associated with higher odds of urine toxicology screening. An equitable, non-biased approach to substance use screening is needed.

Presenting Author(s)

Farnaaz Kia, MD
Cedars Sinai Medical Center
New York, New York, United States

Coauthor(s)

Candace Levian, MD
Resident
Cedars-Sinai Medical Center
Los Angeles, California, United States

AH
Anna Hirsch, MD
Cedars Sinai Medical Center
Los Angeles, California, United States

Naomi Greene, MPH PhD (she/her/hers)
Research Scientist I
Cedars-Sinai Medical Center
Los Angeles, California, United States

KT
Keona Thompson, MD
Resident, Obstetrics and Gynecology
Cedars-Sinai Medical Center
Los Angeles, California, United States

JA
Jennifer Astasio, MS, RN
Perinatal Safety Education Program Coordinator, Labor & Delivery/MFCU/Postpartum
Cedars-Sinai Medical Center
Los Angeles, California, United States

AH
Allison Henry, MD
Cedars Sinai Medical Center
Los Angeles, California, United States

Primary Author(s)
MN
Mariam Naqvi, MD
Assistant Professor, Obstetrics and Gynecology
Cedars-Sinai Medical Center
Los Angeles, California, United States