Screening for Substance Use Disorders in Pregnancy

"In 2023, an estimated 4.9% of pregnant women in the United States reported using illicit substances and 8.4% reported drinking alcohol within the past month.1 Such use, regardless of whether it reflects an underlying substance use disorder (SUD), is associated with adverse outcomes across nearly all domains of maternal and fetal health, including preterm birth,2 fetal anomalies,2 neonatal abstinence syndrome,3 and increased maternal morbidity and mortality.4,5 Substance-related deaths during pregnancy have nearly doubled over the past decade, accounting for approximately 11% of all US pregnancy-related deaths between 2010 and 2019.6

"Despite the heightened risks among pregnant women with SUDs, many women report increased motivation to reduce substance use and have more frequent contact with medical professionals.7,8 This creates an opportunity for healthcare providers to identify pregnant women with SUDs and facilitate timely linkages to treatment.9-12 Nevertheless, pregnant women with SUDs are often unidentified, and only a small fraction (12.8%) receive treatment.13-16

"Improving maternal health outcomes for women with SUDs requires increased efforts to enhance early identification and access to care.17 To this end, universal screening of pregnant and reproductive-age women is recognized as an effective strategy for early identification of SUDs and is considered a national healthcare priority. The US Preventive Task Force recommends SUD screening via a patient interview for all adults over 18 years old,18 and the American College of Obstetricians and Gynecologists recommends incorporating substance use screening into the first prenatal visit as part of comprehensive, universal prenatal care.19 The purpose of screening is to stratify women into risk categories that guide the appropriate level of care. Those at low risk (i.e., no past or current substance use) should receive brief advice and reinforcement of healthy behaviors. Those at moderate risk (i.e., a history of use without meeting SUD criteria) should receive brief motivational interventions and regular follow-up visits. Women who meet diagnostic criteria for an SUD are considered high risk; while they may also benefit from brief motivational interventions, it is recommended that they be referred to specialty SUD treatment.20,21

"Universal screening has been identified as a way to provide effective treatment by identifying pregnant women who need alcohol and/or drug treatment earlier in pregnancy and then connecting them to needed services.17 However, screening rates are often inconsistent, and validated tools specifically designed for use with pregnant women remain underutilized.22,23 In addition, many pregnant women may choose not to disclose substance use due to fear of stigma or potential legal repercussions.24"