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Am J Perinatol 2022; 39(10): 1104-1111
DOI: 10.1055/s-0040-1721688
Original Article

A Prediction Model for Positive Infant Meconium and Urine Drug Tests

Elizabeth A. Simpson
1   Department of Pediatrics, Children's Mercy Kansas City, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
,
David A. Skoglund
1   Department of Pediatrics, Children's Mercy Kansas City, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
,
Sarah E. Stone
2   Department of Population Health, Inova Fairfax Hospital for Children, Falls Church, Virginia
,
Ashley K. Sherman
1   Department of Pediatrics, Children's Mercy Kansas City, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model.

Study Design This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed.

Results Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative.

Conclusion This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative.

Key Points

  • Many common drug screening criteria are not predictive.

  • Four criteria predicted positive infant drug tests.

  • No infant urine drug test is needed if the mother tests negative.

Keywords

prediction model - drug tests - newborns - substance use disorder

Authors' Contribution

E.A.S., D.A.S., and S.E.S. conceptualized and designed the study. Statistical analysis was done by E.A.S. and A.K.S. All authors drafted and critically revised the manuscript for important intellectual content. They acquired, analyzed and interpreted the data. E.A.S. had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.




Publication History

Received: 29 May 2020

Accepted: 02 November 2020

Article published online:
17 December 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Substance Abuse and Mental Health Services Administration.. Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 17–5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2018 . Accessed August 6, 2020 at: https://www.samhsa.gov/data/
    PubMedGoogle Scholar
  • 2 NIDA. Substance Use in Women. 2020 . Accessed August 12, 2020 at: https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/summary
    PubMedGoogle Scholar
  • 3 Wendell AD. Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol 2013; 56 (01) 91-96
    CrossrefPubMedGoogle Scholar
  • 4 American Society of Addiction Medicine. Public Policy Statement on Substance Use, Misuse, and Use Disorders During and Following Pregnancy, with an Emphasis on Opioids. January 18, 2017. Accessed September 7, 2018 at: https://www.asam.org/docs/default-source/public-policy-statements/substance-use-misuse-and-use-disorders-during-and-following-pregnancy.pdf?sfvrsn=644978c2_4
    PubMedGoogle Scholar
  • 5 ACOG Committee on Ethics. Committee opinion no. 633: alcohol abuse and other substance use disorders: ethical issues in obstetric and gynecologic practice. Obstet Gynecol 2015; 125 (06) 1529-1537
    CrossrefPubMedGoogle Scholar
  • 6 Hostage JC, Brock J, Craig W, Sepulveda D. Integrating screening, brief intervention and referral to treatment (SBIRT) for substance use into prenatal care. J Nurse Pract 2020; 24 (04) 412-418
    PubMedGoogle Scholar
  • 7 Records K, Hanko S. Decision support to enhance prenatal care using the screening, brief intervention, and referral to treatment model. J Nurse Practitioners 2016; 12 (09) 605-612
    CrossrefPubMedGoogle Scholar
  • 8 Coleman-Cowger VH, Oga EA, Peters EN, Trocin KE, Koszowski B, Mark K. Accuracy of three screening tools for prenatal substance use. Obstet Gynecol 2019; 133 (05) 952-961
    CrossrefPubMedGoogle Scholar
  • 9 Haight SC, Ko JY, Tong VT. et al. Opioid use disorder documented at delivery hospitalization - United States, 1999-2014. MMWR Morb Mortal Wkly Rep 2018; 67 (31) 845-849
    CrossrefPubMedGoogle Scholar
  • 10 Lester BM, ElSohly M, Wright LL. et al. The Maternal Lifestyle Study: drug use by meconium toxicology and maternal self-report. Pediatrics 2001; 107 (02) 309-317
    CrossrefPubMedGoogle Scholar
  • 11 WHO Library Cataloguing-in-Publication Data. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. World Health Organization 2014. Accessed August 12, 2020 at: https://www.who.int/publications/i/item/9789241548731
    PubMedGoogle Scholar
  • 12 Foley EM. Drug screening and criminal prosecution of pregnant women. J Obstet Gynecol Neonatal Nurs 2002; 31 (02) 133-137
    CrossrefPubMedGoogle Scholar
  • 13 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Cond JG. Research Electronic Data Capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    Google Scholar
  • 14 Oral R, Strang T. Neonatal illicit drug screening practices in Iowa: the impact of utilization of a structured screening protocol. J Perinatol 2006; 26 (11) 660-666
    CrossrefPubMedGoogle Scholar
  • 15 Wood KE, Sinclair LL, Rysgaard CD, Strathmann FG, McMillin GA, Krasowski MD. Retrospective analysis of the diagnostic yield of newborn drug testing. BMC Pregnancy Childbirth 2014; 14: 250
    CrossrefPubMedGoogle Scholar
  • 16 Behnke M, Smith VC. Committee on Substance Abuse, Committee on Fetus and Newborn. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics 2013; 131 (03) e1009-e1024
    CrossrefPubMedGoogle Scholar
  • 17 Metz TD, Allshouse AA, Hogue CJ. et al. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. Am J Obstet Gynecol 2017; 217 (04) 478.e1-478.e8
    CrossrefPubMedGoogle Scholar
  • 18 Metz TD, Stickrath EH. Marijuana use in pregnancy and lactation: a review of the evidence. Am J Obstet Gynecol 2015; 213 (06) 761-778
    CrossrefPubMedGoogle Scholar
  • 19 Fill MA, Miller AM, Wilkinson RH. et al. Educational disabilities among children born with neonatal abstinence syndrome. Pediatrics 2018; 142 (03) e20180562
    CrossrefPubMedGoogle Scholar
  • 20 Warner TD, Roussos-Ross D, Behnke M. It's not your mother's marijuana: effects on maternal-fetal health and the developing child. Clin Perinatol 2014; 41 (04) 877-894
    CrossrefPubMedGoogle Scholar
  • 21 Conner SN, Bedell V, Lipsey K, Macones GA, Cahill AG, Tuuli MG. Maternal marijuana use and adverse neonatal outcomes: a systematic review and meta-analysis. Obstet Gynecol 2016; 128 (04) 713-723
    CrossrefPubMedGoogle Scholar
  • 22 Levy S, Siqueira LM, Ammerman SD. et al. Committee on Substance Abuse. Testing for drugs of abuse in children and adolescents. Pediatrics 2014; 133 (06) e1798-e1807
    CrossrefPubMedGoogle Scholar
  • 23 Montgomery D, Plate C, Alder SC, Jones M, Jones J, Christensen RD. Testing for fetal exposure to illicit drugs using umbilical cord tissue vs meconium. J Perinatol 2006; 26 (01) 11-14
    CrossrefPubMedGoogle Scholar
  • 24 Ostrea Jr EM, Brady MJ, Parks PM, Asensio DC, Naluz A. Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr 1989; 115 (03) 474-477
    CrossrefPubMedGoogle Scholar
  • 25 Schroeder AR, Harris SJ, Newman TB. Safely doing less: a missing component of the patient safety dialogue. Pediatrics 2011; 128 (06) e1596-e1597
    CrossrefPubMedGoogle Scholar
  • 26 Grady D, Redberg RF. Less is more: how less health care can result in better health. Arch Intern Med 2010; 170 (09) 749-750
    CrossrefPubMedGoogle Scholar
  • 27 Kwong TC, Ryan RM. National Academy of Clinical Biochemistry. Detection of intrauterine illicit drug exposure by newborn drug testing. Clin Chem 1997; 43 (01) 235-242
    CrossrefPubMedGoogle Scholar
  • 28 Saitman A, Park H-D, Fitzgerald RL. False-positive interferences of common urine drug screen immunoassays: a review. J Anal Toxicol 2014; 38 (07) 387-396
    CrossrefPubMedGoogle Scholar
  • 29 Substance Use During Pregnancy. Guttmacher Institute. Accessed August 13, 2020: https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy
    PubMedGoogle Scholar
  • 30 Child Welfare Manual. Non-Child Abuse/Neglect Referrals, Subsection 4-Newborn Crisis Assessments. Section 2, Chapter 4. Accessed August 12, 2020 at: https://dssmanuals.mo.gov/child-welfare-manual/
    PubMedGoogle Scholar
  • 31 Wexelblatt SL, Ward LP, Torok K, Tisdale E, Meinzen-Derr JK, Greenberg JM. Universal maternal drug testing in a high-prevalence region of prescription opiate abuse. J Pediatrics 2015; 166 (03) 582-586
    CrossrefPubMedGoogle Scholar
  • 32 Newman L. As Substance Abuse Rises, Hospitals Test Mothers, Newborns. American Association for Clinical Chemistry. Clinical Laboratory News; March 1, 2016. Accessed August 12, 2020 at: https://www.aacc.org/publications/cln/articles/2016/march/as-substance-abuse-rises-hospitals-drug-test-mothers-newborns
    PubMedGoogle Scholar