Factors Associated with Positive Toxicology at Delivery: Insights From the University of Maryland Medical System

Abstract

Objective: To explore factors associated with positive toxicology tests during birthing admissions within a hospital system employing universal toxicology testing.

Methods: A retrospective cross-sectional study from 2019 to 2022, within a health system where toxicology tests are performed routinely during the birth admission. Substance use was defined as a positive toxicology test and race was self-reported. The association between substance use with race and insurance was analyzed. Assessments were made using descriptive statistics, chi-squared tests, and logistic regression models, controlling for maternal age, gestational age, birth year, insurance, and birth hospital. Separate analyses were conducted excluding cannabis from the toxicology evaluations.

Results: Of 37,438 deliveries, 97% (36,323) underwent toxicology testing. Unadjusted odds for positive toxicology tests (including amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, fentanyl, methadone, opioids (all), phencyclidine) were: Black (OR 1.91), Hispanic (OR 0.36), and Other (OR 0.56), compared with White. After adjusting for confounders, all groups showed decreased odds: Black (aOR 0.75), Hispanic (aOR 0.15), and Other (aOR 0.36). For insurance, the unadjusted odds were compared to private insurance: Public (OR 4.18) and Other (OR 1.81). When excluding cannabis, unadjusted odds for Black individuals increased (OR 1.21) while adjusted odds for Black, Hispanic, and 'Other' groups decreased relative to White individuals.

Conclusion: Substance use during pregnancy exhibits sociodemographic variations. Initial unadjusted findings indicated racial disparities in substance use. However, adjusted models shifted these initial observations. Findings highlight the intertwined nature of sociodemographic factors in toxicology test results. Study findings underscore the need for comprehensive research to inform interventions, focusing on racial and socioeconomic inequities.

Keywords: Cannabis in pregnancy; Health disparities; Insurance; Perinatal equity; Race; Structural determinants of health; Substance use in pregnancy; Universal toxicology testing.