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Perinatal Substance Use and the Documentation of Stigmatizing Language in Clinical Notes.
Nursing Research
|March 23, 2026
Summary
Patients with substance use disorders (SUD) experienced more stigmatizing language in clinical notes during birth hospitalization. This highlights the need for clinician training and person-centered language to ensure equitable care.
Area of Science:
- Obstetrics and Gynecology
- Psychiatry
- Health Equity
Background:
- Patients with substance use disorders (SUD) often face clinician bias during pregnancy care.
- Stigmatizing language in electronic health records (EHRs) can perpetuate inequitable care for these patients.
Purpose of the Study:
- To investigate the link between substance use and stigmatizing language in clinical notes from birth hospitalizations.
Main Methods:
- Cross-sectional study analyzing EHR data from 19,094 patients at two urban hospitals (2017-2019).
- Identified patients with SUD using ICD-10 codes and natural language processing (NLP).
- Utilized an NLP algorithm to detect four categories of stigmatizing language in clinical narratives; multivariable logistic regression was performed.
Main Results:
- 1.5% of patients had a documented SUD.
- Patients with SUD showed increased odds of experiencing any stigmatizing language.
- Higher odds of stigmatizing language related to marginalized identities and difficult patient categories were observed in patients with SUD.
Conclusions:
- Patients with SUD were more likely to have stigmatizing language documented during labor and birth.
- Emphasizes the necessity for clinician training in person-centered language and abolitionist strategies to mitigate patient stigmatization.
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