(90) Variation in Toxicology Testing for Substance Exposure In Pregnancy in Michigan Hospitals

Background & Introduction: In the state of Michigan, “mandated reporters are required to report suspected child abuse or neglect if the reporters knows or suspects that a newborn infant has any amount of alcohol, a controlled substance or a metabolite of a controlled substance (whether legal or illegal) in his or her body.” Reporting is not required when due to medical treatment. Historically, clinicians assessing newborns for substance exposure use a comprehensive assessment in order to determine whether reporting for suspected child abuse or neglect is warranted.

Little is known about individual hospital policies and procedures regarding toxicology testing. A prior study of southwestern US states demonstrated variability in toxicology testing policies for pregnant people, but did not address assessment of substance exposed newborns or CPS (Child Protective Services) reporting (Byrd 2023).

This study examines hospital policies on prenatal toxicology testing, newborn toxicology testing, and referral to the child welfare system for suspected abuse and neglect. We assessed variability between hospitals, alignment with state law, and consistency with professional guidelines.

Methods:

Methods: This cross-sectional survey was conducted between February 1 and April 1, 2024. All 76 birthing hospitals in Michigan were invited via email from a membership list-serve. The ten-question survey addressed hospital protocols for prenatal and newborn drug testing, indications for testing in risk-based protocols, informed consent policies, protocols for reporting to CPS, and specific policies for cannabis exposure and patients receiving medication treatment for opioid use disorder. We performed descriptive statistics for quantitative results and content analysis for qualitative short responses.

Results: A total of 29 respondents from the 76 birthing hospitals in Michigan responded to the survey. There were large differences in how hospitals address prenatal and newborn drug testing with approximately one-third (10/29) of hospitals performing universal prenatal drug testing vs. two-thirds (17/29) performing risk-based testing. Most respondents (25/29) used a risk-based testing strategy for newborns. Although guidelines recommend informed consent for all prenatal and newborn drug testing, only 56% (14/25) of respondents required informed consent for prenatal drug testing and even fewer, 24% (6/23) required verbal or written informed consent from a parent before collecting biologic specimens for newborn drug testing. 16 respondents reported all confirmed newborn cannabis exposure to the child welfare system even when there is no concern for abuse or neglect, while 5 respondents reported a CPS report is never filed for cannabis exposure when there is not concern for abuse or neglect.

Conclusion & Discussion: Among Michigan hospitals, we found wide variations in prenatal and newborn drug testing and subsequent referral to CPS. This variation highlights the need for quality improvements to increase concordance with guideline directed care and to reduce the risk of racial bias and overreporting to the child welfare system.

References: 1. Michigan Public Health Code MCL 333.7212. Accessed August 21, 2022. https://legislature.mi.gov/doc.aspx?mcl-333-7212

2. Byrd DP, Bartlett TR. Drug Testing Practices and Policies of Labor and Delivery Units Across the Southeastern United States. J Obstet Gynecol Neonatal Nurs JOGNN. 2023;52(1):72-83. doi:10.1016/j.jogn.2022.10.002

3. Schoneich S, Plegue M, Waidley V, McCabe K, Wu J, Chandanabhumma PP, Shetty C, Frank CJ, Oshman L. Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization. JAMA Netw Open. 2023 Mar 1;6(3):e232058. doi: 10.1001/jamanetworkopen.2023.2058. PMID: 36884249; PMCID: PMC9996400.

4. Shetty C, Oshman L, Costa A, Waidley V, Madlambayan E, Joassaint M, McCabe K, Townsel C, Wu JP, Frank CJ, Chandanabhumma PP. Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals. Ann Fam Med. 2024 Jul-Aug;22(4):271-278. doi: 10.1370/afm.3139. PMID: 39038971; PMCID: PMC11268687.