{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T23:17:43Z","timestamp":1783552663255,"version":"3.55.0"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Addiction Medicine (ASAM) jointly recommend universal substance use screening in pregnancy with a validated tool. Biologic testing with urine drug screening (UDS) is not recommended unless testing would change medical management. Despite recommendations, racial and socioeconomic differences in substance use screening and biological testing exist. We evaluated the impact of an obstetric substance use screening protocol on validated screening, UDS indication documentation, pre-UDS patient assent, and UDS disparities across race, ethnicity, and payor.<\/jats:p>\n                  <jats:p>This retrospective cohort study used electronic health record data before (July 1, 2020\u2013June 9, 2021) and after (June 10, 2021\u2013May 31, 2022) implementation of an obstetric substance use screening protocol at a tertiary care center. Documented, validated screening, UDS indication, and patient assent were assessed among UDS encounters pre- and postintervention. Association of race, ethnicity, and payor with UDS was assessed using generalized estimating equations models pre- and postintervention. Categorical variables were compared using chi-square and Fisher's exact tests.<\/jats:p>\n                  <jats:p>UDS occurred less frequently postintervention than preintervention (1.9% [124\/6,412 encounters] vs. 7.8% [441\/5,658 encounters], p\u2009&lt;\u20090.001). Adjusting for payor, Black individuals had higher odds of UDS (adjusted odds ratio [aOR]\u2009=\u20092.11, 95% confidence interval [CI]: 1.64\u20132.70) than White individuals preintervention; however, there were no differences (aOR\u2009=\u20091.23, 95% CI: 0.81\u20131.87) postintervention. Privately insured individuals had lower odds of UDS preintervention (OR\u2009=\u20090.23, 95% CI: 0.18\u20130.30) and postintervention (OR\u2009=\u20090.08, 95% CI: 0.04\u20130.15) than government-insured individuals. Among those with UDS, none (0\/441) underwent validated screening preintervention versus 36.3% (45\/124) postintervention. Documented UDS indication occurred in 27.9% (123\/441) preintervention versus 55.7% (69\/124) postintervention (p\u2009&lt;\u20090.001). Documented assent occurred in 0.5% (2\/441) of encounters preintervention versus 47.6% (59\/124) postintervention (p\u2009&lt;\u20090.001).<\/jats:p>\n                  <jats:p>Implementation of an obstetric substance use screening protocol was associated with decreasing UDS and increasing validated screening, documented UDS indication, and patient assent. Racial disparities in UDS were reduced postintervention; however, suboptimal screening remained, with persistent disparities by payor.<\/jats:p>","DOI":"10.1055\/a-2764-3361","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:59:48Z","timestamp":1777881588000},"page":"1388-1395","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of a Protocol on Equitable Labor and Delivery Substance Use Screening: A Retrospective Cohort Study"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7349-6460","authenticated-orcid":false,"given":"Jennifer J.M.","family":"Cate","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1601-1812","authenticated-orcid":false,"given":"Siera","family":"Lunn","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adwoa","family":"Baffoe-Bonnie","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronan","family":"Sugrue","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pennilee","family":"West","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Truong","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaattin","family":"Erkanli","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Gilner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenna","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8384-3721","authenticated-orcid":false,"given":"Sarahn","family":"Wheeler","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"B5","DOI":"10.1016\/j.ajog.2019.03.022","article-title":"Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: A report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine","volume":"221","author":"J Ecker","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"100453","DOI":"10.1016\/j.ajogmf.2021.100453","article-title":"Racial differences in indications for obstetrical toxicology testing and relationship of indications to test results","volume":"4","author":"N C Perlman","year":"2022","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"100419","DOI":"10.1016\/j.ajogmf.2021.100419","article-title":"Heterogeneity in prenatal substance use screening despite universal screening recommendations: Findings from the Pregnancy Risk Assessment Monitoring System, 2016-2018","volume":"3","author":"E Patel","year":"2021","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s10995-021-03258-5","article-title":"Racial and ethnic differences in urine drug screening on labor and delivery","volume":"26","author":"M L Winchester","year":"2022","journal-title":"Matern Child Health J"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"e230441","DOI":"10.1001\/jamahealthforum.2023.0441","article-title":"Association of race with urine toxicology testing among pregnant patients during labor and delivery","volume":"4","author":"M Jarlenski","year":"2023","journal-title":"JAMA Health Forum"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"100913","DOI":"10.1016\/j.ajogmf.2023.100913","article-title":"Reduction of racial disparities in urine drug testing after implementation of a standardized testing policy for pregnant patients","volume":"5","author":"J A Peterson","year":"2023","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1089\/jwh.2006.0070","article-title":"The effect of race on provider decisions to test for illicit drug use in the peripartum setting","volume":"16","author":"H V Kunins","year":"2007","journal-title":"J Womens Health (Larchmt)"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/AOG.0b013e31820a6216","article-title":"AGOG Committee Opinion No. 473: Substance abuse reporting and pregnancy: The role of the obstetrician-gynecologist","volume":"117","author":"American College of Obstetricians and Gynecologists","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.whi.2020.05.004","article-title":"Pregnant women's acceptability of alcohol, tobacco, and drug use screening and willingness to disclose use in prenatal care","volume":"30","author":"S M Toquinto","year":"2020","journal-title":"Womens Health Issues"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.nwh.2023.09.009","article-title":"Implementation of a perinatal substance use screening protocol in the outpatient setting","volume":"28","author":"K DiCarlo","year":"2024","journal-title":"Nurs Womens Health"},{"issue":"S 01","key":"ref11","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s10995-023-03842-x","article-title":"Early insights into implementation of universal screening, brief intervention, and referral to treatment for perinatal substance use","volume":"27","author":"S E Reese","year":"2023","journal-title":"Matern Child Health J"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"e1379","DOI":"10.1542\/peds.2008-3525","article-title":"Infant race affects application of clinical guidelines when screening for drugs of abuse in newborns","volume":"125","author":"M A Ellsworth","year":"2010","journal-title":"Pediatrics"},{"issue":"09","key":"ref13","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.1542\/hpeds.2020-005765","article-title":"Toxicology testing in a newborn ICU: Does social profiling play a role?","volume":"11","author":"N C Perlman","year":"2021","journal-title":"Hosp Pediatr"},{"issue":"03","key":"ref14","doi-asserted-by":"crossref","first-page":"e232058","DOI":"10.1001\/jamanetworkopen.2023.2058","article-title":"Incidence of newborn drug testing and variations by birthing parent race and ethnicity before and after recreational cannabis legalization","volume":"6","author":"S Schoneich","year":"2023","journal-title":"JAMA Netw Open"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2764-3361.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T22:48:33Z","timestamp":1783550913000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2764-3361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,29]]},"references-count":14,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,7,8]]},"published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2764-3361","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,29]]}}}