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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Pre-natal and post-natal screening and testing in neonatal abstinence syndrome
1Yale University School of Medicine, Department of Pediatrics, Section of Hospital Medicine, United States.
Insights
Routine screening for substance use in pregnancy reduces stigma and improves care. Newborn toxicology testing increases stigma and is rarely needed, especially for vulnerable populations.
Area of Science:
- Maternal Health
- Substance Use Disorders
- Healthcare Policy
Background:
- Current healthcare practices for screening substance use during pregnancy can inadvertently increase stigma and disengagement from care.
- Biochemical specimen toxicology testing in pregnant individuals and newborns is associated with negative outcomes, particularly for families of color and those in poverty.
Purpose of the Study:
- To evaluate the effectiveness of current substance use screening methods during pregnancy.
- To assess the impact of biochemical toxicology testing on patient engagement and newborn outcomes.
- To advocate for improved screening protocols and reduced reliance on toxicology testing.
Main Methods:
- Review of current literature on substance use screening and toxicology testing in pregnancy.
- Analysis of the impact of these methods on patient stigma, care engagement, and health outcomes.
- Examination of the inequitable distribution of consequences for marginalized families.
Main Results:
- Serial screening with validated questionnaires from the first prenatal visit through delivery is recommended.
- Newborn toxicology testing is often unnecessary and can indicate a failure in provider-patient communication.
- Current evidence suggests limited clinical utility and significant inequitable consequences of newborn toxicology testing.
Conclusions:
- Healthcare systems should prioritize stigma-reducing screening methods for substance use during pregnancy.
- Biochemical toxicology testing for newborns should be used sparingly due to its potential for harm and inequitable outcomes.
- Effective, compassionate communication and timely service connections are crucial for supporting pregnant individuals with substance use disorders.
Abstract:
The way we enact screening for substance use during pregnancy within our healthcare systems can work by decreasing stigma, promoting engagement, and supporting people with reaching the end of their pregnancy in a manner where the newborn can be well supported. The way we enact biochemical specimen toxicology testing for substance use during pregnancy and in newborns contributes to increased stigma, disengagement from care, and potential continuation of uncontrolled substance use up until delivery such that the newborn may not be able to be well supported in the family environment. These effects are inequitably distributed, leading to worse outcomes for families of color and families living in poverty. Serial screening with a validated questionnaire starting at the first prenatal visit and continuing through the delivery hospitalization should occur and be followed up with service connections and substance use disorder diagnosis and treatment. Newborn toxicology testing as a diagnostic tool for risk of withdrawal or the etiology of potential withdrawal symptoms represents a failure in the effectiveness of compassionate communication by healthcare providers with the birthing person. Given the current level of evidence of clinical utility and the inequitable consequences specific to these tests, they are rarely needed.
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