Perinatal Illicit Drug and Marijuana Use: An Observational Study Examining Prevalence, Screening, and Disclosure

To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits. 

Observational study that qualitatively assesses provider screening and patient disclosure of substance use. Setting . Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania. Participants . Pregnant patients and obstetric providers were recruited as participants. 

We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure. 

Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use. 

Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.

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By:  Chang JC, Holland CL, Tarr JA, Rubio D, Rodriguez KL, Kraemer KL, Day N, Arnold RM.

Judy C. Chang, MD, MPH, is with the Department of Obstetrics, Gynecology and Reproductive Sciences and General Internal Medicine, Magee-Womens Research Institute, and the Center for Research in Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 

Cynthia L. Holland, MPH, and Jill A. Tarr, LCSW, ACSW, are with the Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, Pennsylvania. 

Doris Rubio, PhD; Keri L. Rodriguez, PhD; Kevin L. Kraemer, MD, MSc; and Robert M. Arnold, MD, MPH, are with the Division of General Internal Medicine, Department of Internal Medicine; and Nancy Day, PhD, is with the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania. 

Keri L. Rodriguez, PhD, is also with the Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. 

Robert M. Arnold, MD, MPH, is also with the Institute to Enhance Palliative Care, and Director, Pittsburgh, Pennsylvania.

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