Content Analysis of Maternal Toxicology Testing Policies to Inform Equity in Substance Use Disorder Identification

Area of Science:

• Public Health
• Maternal Health
• Substance Use Disorders

Background:

• Perinatal substance use and substance use disorders (SUDs) impact maternal and infant health.
• Existing hospital policies for maternal screening lack standardization and can perpetuate stigma.
• Equitable screening is essential for timely intervention and improved dyad outcomes.

Purpose of the Study:

• To analyze existing hospital-level policies in New York City (NYC) concerning perinatal substance use and SUDs.
• To provide a guide for developing equitable hospital policies for maternal substance use screening.
• To identify best practices and gaps in current policy approaches.

Main Methods:

• Qualitative thematic content analysis of seven NYC hospital-level maternal toxicology policies (2021-2022).
• Policies were analyzed using the Health Equity Impact Assessment framework.
• Two researchers conducted thematic analysis, with two others reviewing identified themes.

Main Results:

• Four distinct policy approaches (Types A, B, C, D) were identified among the seven policies.
• Policies varied in screening tools, toxicology testing, consent, and referral processes.
• Some policies risk reinforcing stigma by focusing on non-indicative high-risk characteristics.

Conclusions:

• Multidisciplinary, evidence-based guidelines are needed for perinatal substance use and SUD management.
• Integration of screening, brief intervention, and referral to treatment (SBIRT) is recommended over sole reliance on toxicology tests.
• Findings can inform the development of equitable policies to improve maternal and infant outcomes.