(986) Implementation of universal screening for substance use in pregnancy in a public healthcare system

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Reported rates of maternal substance use include 6% illicit drugs, 10% tobacco, and 10% alcohol from the 2019 National Survey on Drug Use and Health. We evaluate the implementation of a validated, universal screening tool to identify self-reported substance use disorder (SUD) in pregnancy at an inner-city public health system.

Study Design: We implemented universal screening for SUD in a prenatal health system including 10 community-based prenatal clinics, a centralized MFM clinic, the emergency department (ED), and Labor and Delivery Triage (L&D). Screening occurred at the time of first contact using National Institute on Drug Abuse (NIDA) Quick Screen V1.0 integrated into the electronic health record; any response other than “Never” was considered positive. Protocols were implemented for intervention and management. Screen completion rates and results were evaluated. Neonates affected by maternal SUD per ICD-10 code at hospital discharge were compared to maternal NIDA data among delivered pregnancies.

Results: From July 28, 2021 through June 25, 2022, 12,796(85%) of 15,095 pregnancies were screened across all care domains (Table). Positive responses to past-year substance use occurred in 18% of screened pregnancies in all outpatient clinics, 6% in ED, and 2% on L&D. Past-year illegal drug use was most frequently reported in MFM clinic attendees (12%), whereas alcohol use was most frequently reported among community clinic attendees (11%) (Figure). Among women delivered at our institution, 0.5% of neonates were coded as affected by maternal SUD, most born to women screened in the ED and MFM clinic.

Conclusion: Following successful implementation of universal NIDA screening in a public prenatal system, rates of maternal substance use are consistent with national data. Future efforts will address challenges to ED and L&D screening, and target highest-risk substance use patterns for intervention. ICD-10 coding may not identify all neonates affected by maternal SUD.

Primary & Presenting Author(s)

Emily H. Adhikari, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Coauthor(s)

Elaine L. Duryea, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States

JM
Joyce Miller, RN
Director of Nursing Advanced Practice, Women's Health Centers
Parkland Health
Dallas, Texas, United States

David B. Nelson, MD
Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Anne M. Ambia, MD
Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States