PRP088: The Effect of Maternal Race and Other Factors on Meconium Drug Testing: A Retrospective Cohort Study to Achieve Racial Equity
Lauren Oshman, MD, MPH, FAAFP, Dipl ABOM; Victoria Waidley, BS; Christopher Frank, MD, PhD; Sebastian Schoneich
Abstract
Context: In the state of Michigan, physicians are required to report newborns with known or suspected exposure to alcohol or a controlled substance to Child Protective Services (CPS). Historically, Black mothers and babies have undergone higher rates of substance use testing than other racial and ethnic groups. This racial discrimination is propagated by inconsistent, bias-prone screening of mothers for substance use at the birth hospitalization that leads to meconium drug testing of newborns. Positive meconium tests trigger mandatory reporting, subjecting Black mothers to higher rates of CPS reporting and punitive legal consequences. Prior studies testing universal screening and risk-factor based meconium testing for illegal drugs have not been shown to reduce racial bias.
Objective: This study seeks to assess the patterns of substance use testing in the intrapartum and neonatal period at a large academic health system in the Midwest with particular focus on the relationship between maternal race and meconium drug testing during birth hospitalization. We aim to do so using an anti-racism praxis in our research design and implementation in order to center the experience of Black mothers and babies to better understand the harmful consequences of current practices.
Study Design: This is a retrospective cohort study.
Dataset: Quantitative data set derived from the electronic health record.
Population studied: Inclusion criteria include all mother-infant dyads where the mother received prenatal care through the health system and the neonate was born at the main hospital of the health system, starting from 2014 through the end of 2020.
Outcome measures: The primary study outcome is whether or not a meconium drug test was ordered on a neonate. Meconium drug testing will be evaluated for associations with maternal factors including race, age, zip code, insurance status, history of positive urine drug testing in pregnancy, and pregnancy complications.
Results: This study is in progress. We hypothesize that the rate of meconium drug testing will be higher for neonates of Black mothers and mothers residing in zip codes with a higher level of social deprivation when adjusted for other factors.
Conclusions: The results of this study will inform the implementation of interventions to reduce racial disparities in meconium drug testing.
Objective: This study seeks to assess the patterns of substance use testing in the intrapartum and neonatal period at a large academic health system in the Midwest with particular focus on the relationship between maternal race and meconium drug testing during birth hospitalization. We aim to do so using an anti-racism praxis in our research design and implementation in order to center the experience of Black mothers and babies to better understand the harmful consequences of current practices.
Study Design: This is a retrospective cohort study.
Dataset: Quantitative data set derived from the electronic health record.
Population studied: Inclusion criteria include all mother-infant dyads where the mother received prenatal care through the health system and the neonate was born at the main hospital of the health system, starting from 2014 through the end of 2020.
Outcome measures: The primary study outcome is whether or not a meconium drug test was ordered on a neonate. Meconium drug testing will be evaluated for associations with maternal factors including race, age, zip code, insurance status, history of positive urine drug testing in pregnancy, and pregnancy complications.
Results: This study is in progress. We hypothesize that the rate of meconium drug testing will be higher for neonates of Black mothers and mothers residing in zip codes with a higher level of social deprivation when adjusted for other factors.
Conclusions: The results of this study will inform the implementation of interventions to reduce racial disparities in meconium drug testing.
Diane Harper
harperdi@med.umich.edu 11/21/2021It is wonderful to see your work at NAPCRG! Can urine drug screening throughout pregnancy be routinized rather than after the fact with mds? This is really good work! Glad to see this team working together!