Substance Use in Pregnant Women Using the Emergency Department: Undertested And Overlooked?

Introduction: The objective was to determine if pregnant women visiting the emergency department (ED) are tested for substance use as frequently as non-pregnant women. Methods: We captured all ED visits over a six-year period (2010-2016) from a single community hospital and identified women of childbearing age, defined for our study as 11-50 years old. We collected demographic data including age in years, ethnicity, body mass index, marital status, disposition, last encounter department, method of arrival, and day of week. An independent binary variable was created based on whether the woman was tested for alcohol or drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, opioids) during her visit. We then compared rates of testing for substance use by pregnancy status. Results: We identified 61,222 ED visits by women of childbearing age (range 11-50, mean 30.5, standard deviation 9.6) over a six-year period from 2010-2016. Of the 57,360 non-pregnant women, 4.14% were tested compared to 1.04% of the 3,862 pregnant women tested with a relative risk of 0.25 (p<0.001, 95% confidence interval [CI] [0.183-0.341]). The most highly tested chief complaints for all women – psychiatric or substance use concerns – showed pregnant women were still 37% and 54% less likely to be tested, respectively (risk ratio [RR] 0.46, 95% CI [0.19-1.13]; RR 0.63, 95% CI [0.41-0.96]). Beyond pregnancy status, we found no significant interaction between patient demographics and substance use testing. Conclusion: Pregnant women presenting to the ED were 75% less likely to be tested for drug or alcohol use than non-pregnant women. Our study showed only pregnancy status as a statistically significant variable in drug- and alcohol-screening rates when pregnant and non-pregnant patient chief complaints and demographics were compared. Increased attention to the screening of pregnant women for substance use may be necessary to provide adequate care and intervention to this population