Accuracy of Three Screening Tools for Prenatal Substance Use

Area of Science:

• Obstetrics and Gynecology
• Addiction Medicine
• Public Health

Background:

• Prenatal substance use poses significant risks to both maternal and fetal health.
• Accurate screening tools are essential for early identification and intervention in pregnant populations.
• Existing screening methods vary in their effectiveness and applicability across diverse demographic groups.

Purpose of the Study:

• To evaluate and compare the diagnostic accuracy of three distinct screening tools for illicit drug use and prescription drug misuse in pregnant women.
• To determine the sensitivity, specificity, and reliability of the 4P's Plus, NIDA Quick Screen-ASSIST, and SURP-P scales.
• To identify the most clinically useful screening tool for prenatal substance use detection.

Main Methods:

• A prospective cross-sectional study involving 500 pregnant women across different trimesters.
• Administration of three index screening tools: 4P's Plus, NIDA Quick Screen-ASSIST, and SURP-P scale.
• Validation against reference standards including urine and hair drug testing, with test-retest reliability assessed via telephone interviews.

Main Results:

• The SURP-P demonstrated a sensitivity of 92.4% and specificity of 21.8%, while the 4P's Plus showed 90.2% sensitivity and 29.6% specificity.
• The NIDA Quick Screen-ASSIST reported 79.7% sensitivity and 82.8% specificity.
• Test-retest reliability was high for all tools (0.77–0.84). Validity indices varied by age and race, but not by trimester.

Conclusions:

• The SURP-P and 4P's Plus exhibit higher sensitivity and negative predictive values, making them more suitable for screening pregnant women for substance use.
• The NIDA Quick Screen-ASSIST, while having higher specificity, may miss more cases.
• Implementing a validated and effective screening tool is critical for prompt intervention and improved maternal-fetal outcomes.