ACOG: Toxicology Testing in Pregnancy Evaluating the Role of Social Profiling

Maternal morbidity attributable to substance use is high, and illicit substance use in pregnancy occurs regardless of racial or socioeconomic status.1–4 National guidelines promote universal screening for substance use in pregnancy but not universal testing.5,6 In practice, toxicology testing is inconsistently obtained, with substantial repercussions associated with positive test results, including stigmatization, criminalization, prolonged hospital stay, and mother–child separation.7–10 Our study aimed to assess whether perinatal toxicology testing was associated with maternal demographics and, secondarily, to describe documented indications for testing and relationships of indications with positive results.


This Partners Human Research Committee (#2019P001124)–approved retrospective cohort study reviewed all deliveries at one institution from May 30, 2015, to December 31, 2018, using International Classification of Diseases, Tenth Revision and Current Procedural Terminology codes to identify mothers who underwent toxicology testing in inpatient or triage units. Chart review of patients with toxicology testing in 2018 was performed for validation and to determine testing indications.

Age, race, ethnicity, marital status, and mean income by ZIP code of residence were collected for all mothers. History of substance use, medication-assisted treatment, and indication for testing as noted by ordering health care professional were collected by chart review for mothers who delivered in 2018.

Data were analyzed using SAS 9.4. Sociodemographic characteristics were examined using χ2, Fisher exact, or Wilcoxon rank sum tests. Adjusted logistic regression models were used to assess the relationship between mothers who had toxicology testing and those who did not. Models were adjusted for age, race, marital status, and mean income by ZIP code.

doi: 10.1097/AOG.0000000000003986

ACOG: Toxicology Testing in Pregnancy Evaluating the Role of Social Profiling