HomeCannabis MedicineAssessing the Clinical Utility of Toxicology Testing in the Peripartum Period

Assessing the Clinical Utility of Toxicology Testing in the Peripartum Period

April 20, 2023

Am J Obstet Gynecol MFM. 2023 Apr 6:100963. doi: 10.1016/j.ajogmf.2023.100963. Online ahead of print.

ABSTRACT

BACKGROUND: Toxicology testing is frequently used as a means of gathering objective data about substance use in pregnancy, but little is known about the clinical utility of testing in the peripartum setting.

OBJECTIVES: We aimed to characterize the utility of obtaining maternal-neonatal dyad toxicology testing at the time of delivery.

STUDY DESIGN: We performed a retrospective chart review of all deliveries in a single healthcare system in Massachusetts between 2016-2020 andidentified deliveries witheither maternal or neonatal toxicology testingat delivery. An unexpected result was definedas a positive test for a non-prescribed substance that was not known based on clinical history, self-report, or previous toxicology testing within a week of delivery, excluding results for cannabis.We evaluated the characteristics of maternal-infant dyads with unexpected positive results, unexpected positive results by rationale for testing, changes in clinical management after an unexpected positive test, and maternal outcomes in the year after delivery using descriptive statistics.

RESULTS: Of 2036 maternal-infant dyads with toxicology tests performed during the study period, there were 80 (3.9%) with an unexpected positive result.Diagnosis of substance use disorder (SUD)with active use in the last two yearswas the clinical rationalefor testing that yielded the greatest number of unexpected positive results (10.7% of total tests ordered for this rationale). Inadequate prenatal care (5.8%), maternal use of medication for opioid use disorder (3.8%), maternal medical indications such as hypertension or placental abruption (2.3%), history of SUD in remission (1.7%), or maternal cannabis use (1.6%) yielded lower rates of unexpected results compared with a recent SUD (within the last 2 years). Based on findings solely from unexpected tests, 42% of dyads were referred to child protective services, 30% of dyads had no documentation of maternal counseling during delivery hospitalization, and 31% did not receive breastfeeding counseling after an unexpected test. 22.8% had monitoring for neonatal opioid withdrawal syndrome (NOWS).Postpartum, 26 (32.5%) were referred to SUD treatment, 31 (38.8%) attended a postpartum mental health visit, and only 26 (32.5%) attended a postpartum visit. Fifteen individuals (18.8%) were readmitted in the year after delivery, all for substance-related medical complications.

CONCLUSIONS: Unexpected positive toxicology resultsat delivery were uncommon, particularly when tests were sent for frequently used clinical rationales for testing, suggesting a need to revisit guidelines surrounding appropriateness of indications for toxicology testing. The poor maternal outcomes in this cohort highlight a missed opportunity for maternal connection to counseling and treatment in the peripartum period.

PMID:37030508 | DOI:10.1016/j.ajogmf.2023.100963

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About The Author

Patrick Blanchard MD

Meet Dr. Blanchard Dr. Blanchard’s medical practice is an embodiment of Integrative health which brings conventional and complementary approaches together in a coordinated way. Conveniently located in sunny Florida and over the internet with ValiseMD’s secure HIPPA compliant telXmed servers. Since 1994, patients with a wide range of challenging medical problems have achieved optimum health using the best of natural medicine, judiciously combined with high-tech innovations. Breakthroughs are often achieved even after patients have consulted mainstream specialists and holistic practitioners. Dr. Blanchard is founder and CEO of ValiseMD, Inc. He is board certified in Family Medicine since 1994 and awarded Fellow of the American Academy of Family Physicians in 2001. He received the ‘Teacher of the Year’ award from the University of Kansas School of Medicine at completion of his residency in Family Medicine. He completed a fellowship at Wake Forest University in the field of vascular neurosonology. He holds a medical patent in the field of Gastroenterology. He holds an unrestricted license to practice medicine and surgery in Florida. He started his medical career as a Emergency Medical Technician, then as a Paramedic and later a Medical Doctor.