An Integrative Review Examining Barriers to Universal Screening for Substance Use in Pregnant Women

To review and appraise the literature describing the individual- and system-level barriers preventing universal screening of pregnant individuals for substance use in prenatal care settings.

A search was conducted using the Whittemore and Knafl framework for integrative reviews (2005) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords and MeSH terms were identified and searched in the PubMed and CINAHL electronic databases.

Inclusion criteria were peer-reviewed articles published in English from January 2014 to February 2024. Review papers, opinion papers, and commentaries were excluded from the review. The search across the databases yielded 773 results. Duplicates and irrelevant works were removed, leaving 13 articles as the focus of this review.

Data extraction was guided by the PRISMA guidelines. Data were extracted from each article and critically appraised using the Critical Appraisal Skills Programme guidelines.

Four common themes describing barriers to screening for substance use in pregnant individuals emerged in the review: Insufficient Time and Resources, Legal and Ethical Concerns, Lack of Knowledge and Training, and Provider-Patient Relationship.

Nursing leaders and health care providers should systematically address the legal, ethical, technological, and practical obstacles to universal prenatal substance use screening, focusing on individual provider characteristics, state policies, education and training, and other key factors discussed in this review. Nursing leaders are poised to alter the trajectory of declining maternal and child health outcomes by reshaping the lens through which prenatal substance use is viewed and care is practiced. Lessons from this review will inform further examination and solutions to the problem, resulting in universal prenatal screening.