Substance Use Screening During Pregnancy

"Despite widespread recommendations for universal substance use screening during pregnancy,21,22,32 fewer than two-thirds of pregnant women in the nationally representative sample reported being asked about their use of drugs or alcohol. This prevalence is notably lower than estimates from a prior study, indicating that more than 80% of women are being screened for drug and/or alcohol use during prenatal care visits.38 Furthermore, only 10% of the pregnant women in the sample who met criteria for a SUD reported receiving treatment during the past year—far lower than rates observed in the general population, where approximately 19.3% of individuals in need of SUD treatment report receiving it within the past year.1 Together, these findings underscore persistent and substantial gaps in the continuum of care for pregnant women.

"Universal substance use screening implies that every pregnant woman, regardless of her social status, educational level, race, or ethnicity, is asked about her use of drugs and alcohol during prenatal care appointments. This does not include formal screenings for SUDs, which remain rare in routine obstetric visits. However, consistent with prior research, study findings suggest that the ideal of universal screening is often not realized in practice, reflecting system-level gaps in how screening practices and policies are implemented and monitored within routine prenatal care.32,38 Similar to previous studies, we observed racial disparities in screening practices among pregnant women. However, whereas prior research has reported higher screening rates among women of color compared to White women,25,38 we found that Black/African American, Native American/Alaska Native, Pacific Islander/Native Hawaiian, Asian, and Hispanic/Latinx women had lower odds of being screened for drug and alcohol use during pregnancy, while multiracial women had nearly twice the odds of being screened as White women. As racial identities are complex, it is unclear why multiracial women in this sample reported higher rates of screening than other racially minoritized populations. The higher odds observed among multiracial women may reflect implicit racial bias that can influence patient-provider interactions rather than patient-reported need.39 These findings underscore the importance of more granular examinations of race and screening practices, especially within the structural and organizational systems in which screening decisions are made. Other studies have similarly found that racially minoritized women are less likely to be screened: A recent national evaluation of screening practices among pregnant women found lower screening prevalence among American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and multiracial women compared to those identifying as Hispanic or Latino, non-Hispanic Black or African American, and non-Hispanic White.32 Differences between the current findings and prior studies may be due to the variation in how screening is conducted (i.e., patient self-report versus standardized instrument) and differences in study populations across various time periods. Nonetheless, these findings suggest that screening practices vary across racial and ethnic groups, highlighting the need for further investigation to disentangle these patterns and the underlying mechanisms that drive them."