Adopt Universal Screening for Pregnant People - Revision history

BasilSavitsky: /* Introductory Paragraph */

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	With substance use disorder and the opioid epidemic rising, so is the use of prenatal substance use. While pregnancy can be exciting for others, for those with an SUD, there is an immense amount of stress added to their lives. Not only do they face negative health consequences for their unborn baby and themselves, they face public scrutiny and shame along with potential legal repercussions depending on their local and state laws. Early identification of substance use allows for early intervention and treatment which minimizes potential harms to the mother and her pregnancy. <ref>http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf</ref> ~~There~~ is no current uniform protocol for substance testing among pregnant patients, with localities and hospitals patch-working their own models. ~~They often~~ argue against universal screening because of the belief that pregnant people won’t seek out or continue prenatal care out of fear of prosecution or having their child removed from their care. However, selective screening based on “risk factors” perpetuates stigma and misses most people with problematic use. <ref>http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf </ref> Further, risk-based screening has been shown to lead to implicit bias, with practitioners using previous “red-flag” history information to decide if a patient is at risk for an SUD. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> A 2017 study showed that practitioners who used risk-based screening showed “as much implicit bias as the public” and the results were poor prenatal care treatment. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> <ref>https://www.researchgate.net/publication/314162458_Implicit_bias_in_healthcare_professionals_A_systematic_review</ref> Along with early detection and treatment interventions, universal screening is a way to combat implicit bias that negatively impacts the most vulnerable pregnant people.		With substance use disorder and the opioid epidemic rising, so is the use of prenatal substance use. While pregnancy can be exciting for others, for those with an SUD, there is an immense amount of stress added to their lives. Not only do they face negative health consequences for their unborn baby and themselves, they face public scrutiny and shame along with potential legal repercussions depending on their local and state laws. Early identification of substance use allows for early intervention and treatment which minimizes potential harms to the mother and her pregnancy. <ref>http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf</ref> Unfortunately, there is no current uniform protocol for substance testing among pregnant patients, with localities and hospitals patch-working their own models. Some people argue against universal screening because of the belief that pregnant people won’t seek out or continue prenatal care out of fear of prosecution or having their child removed from their care. However, selective screening based on “risk factors” perpetuates stigma and misses most people with problematic use. <ref>http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf </ref> Further, risk-based screening has been shown to lead to implicit bias, with practitioners using previous “red-flag” history information to decide if a patient is at risk for an SUD. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> A 2017 study showed that practitioners who used risk-based screening showed “as much implicit bias as the public” and the results were poor prenatal care treatment. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> <ref>https://www.researchgate.net/publication/314162458_Implicit_bias_in_healthcare_professionals_A_systematic_review</ref> Along with early detection and treatment interventions, universal screening is a way to combat implicit bias that negatively impacts the most vulnerable pregnant people.

	= Key Information =		= Key Information =

BasilSavitsky: /* Key Information */

2024-12-10T00:13:59Z

Key Information

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	*Identify individuals who have dependence and provide rapid access to care		*Identify individuals who have dependence and provide rapid access to care

	~~Brief~~ Screening consists of the provider asking a series of questions that can help to identify where patients fall along a continuum of substance use, not merely just “addicted” or “non-addicted.” SBIRT’s model of substance use has six categories: <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref>		Screening consists of the provider asking a series of questions that can help to identify where patients fall along a continuum of substance use, not merely just “addicted” or “non-addicted.” SBIRT’s model of substance use has six categories: <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref>
	*abstinence		*abstinence
	*experimental use		*experimental use

BasilSavitsky: /* Introductory Paragraph */

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	With substance use disorder and the opioid epidemic rising, so is the use of prenatal substance use. While pregnancy can be exciting for others, for those with an SUD, there is an immense amount of stress added to their lives. Not only do they face negative health consequences for their unborn baby and themselves, they face public scrutiny and shame along with potential legal repercussions depending on their local and state laws.		With substance use disorder and the opioid epidemic rising, so is the use of prenatal substance use. While pregnancy can be exciting for others, for those with an SUD, there is an immense amount of stress added to their lives. Not only do they face negative health consequences for their unborn baby and themselves, they face public scrutiny and shame along with potential legal repercussions depending on their local and state laws. Early identification of substance use allows for early intervention and treatment which minimizes potential harms to the mother and her pregnancy. <ref>http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf</ref> There is no current uniform protocol for substance testing among pregnant patients, with localities and hospitals patch-working their own models. They often argue against universal screening because of the belief that pregnant people won’t seek out or continue prenatal care out of fear of prosecution or having their child removed from their care. However, selective screening based on “risk factors” perpetuates stigma and misses most people with problematic use. <ref>http://www.cffutures.org/files/webinar-handouts/Substance%20Use%20in%20Pregnancy_Final.pdf </ref> Further, risk-based screening has been shown to lead to implicit bias, with practitioners using previous “red-flag” history information to decide if a patient is at risk for an SUD. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> A 2017 study showed that practitioners who used risk-based screening showed “as much implicit bias as the public” and the results were poor prenatal care treatment. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> <ref>https://www.researchgate.net/publication/314162458_Implicit_bias_in_healthcare_professionals_A_systematic_review</ref> Along with early detection and treatment interventions, universal screening is a way to combat implicit bias that negatively impacts the most vulnerable pregnant people.
	There is no current uniform protocol for substance testing among pregnant patients, with localities and hospitals patch-working their own models. They often argue against universal screening because of the belief that pregnant people won’t seek out or continue prenatal care out of fear of prosecution or having their child removed from their care. Further, risk-based screening has been shown to lead to implicit bias, with practitioners using previous “red-flag” history information to decide if a patient is at risk for an SUD. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> A 2017 study showed that practitioners who used risk-based screening showed “as much implicit bias as the public” and the results were poor prenatal care treatment. <ref>https://www.texmed.org/Template.aspx?id=54015</ref> <ref>https://www.researchgate.net/publication/314162458_Implicit_bias_in_healthcare_professionals_A_systematic_review</ref> Along with early detection and treatment interventions, universal screening is a way to combat implicit bias that negatively impacts the most vulnerable pregnant people.

	= Key Information =		= Key Information =

BasilSavitsky: /* Key Information */

2024-12-10T00:08:36Z

Key Information

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	Along with all of these harmful impacts of substance use on women in general, substance use also places women of reproductive age at a heightened risk for unplanned pregnancy. Medical provider training and improved local support for prevention in this area could potentially reduce the number of people who knowingly or unknowingly become pregnant and expose their unborn children to substances. Physicians can also screen and empower people who use substances to seek treatment or take precautions so as to not become pregnant through the use of contraceptives.		Along with all of these harmful impacts of substance use on women in general, substance use also places women of reproductive age at a heightened risk for unplanned pregnancy. Medical provider training and improved local support for prevention in this area could potentially reduce the number of people who knowingly or unknowingly become pregnant and expose their unborn children to substances. Physicians can also screen and empower people who use substances to seek treatment or take precautions so as to not become pregnant through the use of contraceptives.

	'''Screening, Brief Intervention, and Referral to Treatment (SBIRT).''' <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref>		'''Screening, Brief Intervention, and Referral to Treatment (SBIRT).''' The goal of SBIRT is to identify individuals who are unaware that their behaviors are putting them at risk for developing more serious issues. With feedback and support from medical providers, these individuals have the opportunity to make an informed decision and change their current behavior or to seek treatment if needed. If a patient is deemed “moderate” or “high risk” or having “problematic use” the provider can provide a brief intervention and referral for treatment. SBIRT can be implemented with minimal time and effort on behalf of the provider. The impact SBIRT has on the patient is invaluable and helps to connect patients who need education and referral to treatment. <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref> The objectives of SBIRT are directly applicable to the use in maternity care and include: <ref>https://www.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf</ref>
	Brief Screening consists of the provider asking a series of questions that can help to identify where patients fall along a continuum of substance use, not merely just “addicted” or “non-addicted.” SBIRT’s model of substance use has six categories:
			*Educate people about the risks of alcohol and other drugs
			*Make people aware of their use and whether it may be creating health risks for them
			*Decrease general use so as to reduce the societal risk and burden of the effects of overuse
			*Identify individuals who have dependence and provide rapid access to care

			Brief Screening consists of the provider asking a series of questions that can help to identify where patients fall along a continuum of substance use, not merely just “addicted” or “non-addicted.” SBIRT’s model of substance use has six categories: <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref>
	*abstinence		*abstinence
	*experimental use		*experimental use
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	*binge use		*binge use
	*abuse		*abuse
	*substance use disorder		*substance use disorder

	The goal of SBIRT is to identify individuals who are unaware that their behaviors are putting them at risk for developing more serious issues. With feedback and support from medical providers, these individuals have the opportunity to make an informed decision and change their current behavior or to seek treatment if needed. If a patient is deemed “moderate” or “high risk” or having “problematic use” the provider can provide a brief intervention and referral for treatment. SBIRT can be implemented with minimal time and effort on behalf of the provider. The impact SBIRT has on the patient is invaluable and helps to connect patients who need education and referral to treatment. <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref>

	= Relevant Research =		= Relevant Research =

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Available Tools & Resources

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	*'''SAFE Project:''' See the wiki titled "Expand SBIRT Program" for more detailed information on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool used as an prevention/early intervention method at screening for substance use in the general population. <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>		*'''SAFE Project:''' See the wiki titled "Expand SBIRT Program" for more detailed information on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool used as an prevention/early intervention method at screening for substance use in the general population. <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>

	*Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). This brief delineates an official position statement against reporting requirements which result in incarceration or other punitive legal actions against people because of a substance use disorder in pregnancy -- while at the same time supporting universal screening to facilitate early identification and treatment of substance use. <ref>https://onlinelibrary.wiley.com/doi/full/10.1111/1552-6909.12531</ref>		*'''Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN).''' This brief delineates an official position statement against reporting requirements which result in incarceration or other punitive legal actions against people because of a substance use disorder in pregnancy -- while at the same time supporting universal screening to facilitate early identification and treatment of substance use. <ref>https://onlinelibrary.wiley.com/doi/full/10.1111/1552-6909.12531</ref>

	*Indiana Perinatal Quality Improvement Collaborative (IPQIC). This website includes guidance documents generated by the Hospital Levels of Care Task Force. <ref>https://www.in.gov/health/laboroflove/files/Validated-Screening-Tools-Final.pdf</ref>		*'''Indiana Perinatal Quality Improvement Collaborative (IPQIC).''' This website includes guidance documents generated by the Hospital Levels of Care Task Force. <ref>https://www.in.gov/health/laboroflove/files/Validated-Screening-Tools-Final.pdf</ref>

	*ProPublica and World Population Review. Both of these resources provide state-by-states policy and consequences regarding screening/positive prenatal substance use. <ref>https://worldpopulationreview.com/state-rankings/states-that-drug-test-newborns</ref>		*'''New England’s SBIRT-based Prenatal Screening Outline.''' This provides recommended tools, how to align them with SBIRT, a process map, examples, billing/coding guides, brief intervention guide, and treatment referral plan. <ref>http://www.nnepqin.org/wp-content/uploads/2018/03/03.-SBIRT-for-Substance-Use-During-Pregnancy_REV-03.15.18.pdf</ref>

			*'''ProPublica and World Population Review.''' Both of these resources provide state-by-states policy and consequences regarding screening/positive prenatal substance use. <ref>https://worldpopulationreview.com/state-rankings/states-that-drug-test-newborns</ref>
	<ref> https://projects.propublica.org/graphics/maternity-drug-policies-by-state </ref>		<ref> https://projects.propublica.org/graphics/maternity-drug-policies-by-state </ref>

	*'''New England’s SBIRT-based Prenatal Screening Outline.''' This provides recommended tools, how to align them with SBIRT, a process map, examples, billing/coding guides, brief intervention guide, and treatment referral plan. <ref>http://www.nnepqin.org/wp-content/uploads/2018/03/03.-SBIRT-for-Substance-Use-During-Pregnancy_REV-03.15.18.pdf</ref>

	= Promising Practices =		= Promising Practices =

BasilSavitsky: /* Available Tools & Resources */

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Available Tools & Resources

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	=Available Tools & Resources=		=Available Tools & Resources=

	'''SAFE Project:'''		*'''SAFE Project:''' See the wiki titled "Expand SBIRT Program" for more detailed information on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool used as an prevention/early intervention method at screening for substance use in the general population. <ref>https://www.yoursafesolutions.us/wiki/Expand_SBIRT_Program</ref>
	*See the wiki titled "Expand SBIRT ~~in Maternity Care Clinics~~" for more detailed information on the ~~use of the~~ SBIRT tool ~~for mother's and their pregnancies~~ as a method ~~to prevent/intervene in~~ substance use ~~disorders~~.<ref>https://www.yoursafesolutions.us/wiki/~~Expand_SBIRT_in_Maternity_Care_Clinics~~</ref>

	~~'''Additional Tools & Resources:'''~~

	*Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). This brief delineates an official position statement against reporting requirements which result in incarceration or other punitive legal actions against people because of a substance use disorder in pregnancy -- while at the same time supporting universal screening to facilitate early identification and treatment of substance use. <ref>https://onlinelibrary.wiley.com/doi/full/10.1111/1552-6909.12531</ref>		*Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). This brief delineates an official position statement against reporting requirements which result in incarceration or other punitive legal actions against people because of a substance use disorder in pregnancy -- while at the same time supporting universal screening to facilitate early identification and treatment of substance use. <ref>https://onlinelibrary.wiley.com/doi/full/10.1111/1552-6909.12531</ref>
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	*ProPublica and World Population Review. Both of these resources provide state-by-states policy and consequences regarding screening/positive prenatal substance use. <ref>https://worldpopulationreview.com/state-rankings/states-that-drug-test-newborns</ref>		*ProPublica and World Population Review. Both of these resources provide state-by-states policy and consequences regarding screening/positive prenatal substance use. <ref>https://worldpopulationreview.com/state-rankings/states-that-drug-test-newborns</ref>
	<ref> https://projects.propublica.org/graphics/maternity-drug-policies-by-state </ref>		<ref> https://projects.propublica.org/graphics/maternity-drug-policies-by-state </ref>

			*'''New England’s SBIRT-based Prenatal Screening Outline.''' This provides recommended tools, how to align them with SBIRT, a process map, examples, billing/coding guides, brief intervention guide, and treatment referral plan. <ref>http://www.nnepqin.org/wp-content/uploads/2018/03/03.-SBIRT-for-Substance-Use-During-Pregnancy_REV-03.15.18.pdf</ref>

	= Promising Practices =		= Promising Practices =

BasilSavitsky: /* Key Information */

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Key Information

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	*family history of substance use		*family history of substance use
	*women of color and women on public health insurance had higher rates of prenatal substance use.		*women of color and women on public health insurance had higher rates of prenatal substance use.

			Women who were exposed to adverse childhood experiences (ACEs) and are socioeconomically vulnerable have a greater risk of using illicit substances, tobacco, and alcohol. <ref>https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03591-1</ref> White pregnant people are more likely to use tobacco when compared to black and Hispanic populations. <ref>https://www.samhsa.gov/data/sites/default/files/Spot062PregnantRaceEthnicity2012/Spot062PregnantRaceEthnicity2012.pdf</ref> During pregnancy, Black people are more likely to use illicit substances when compared to Hispanics and white people. This data shows that prenatal substance use is present among multiple races and ethnicities. Therefore, medical providers and public health professionals should intervene by identifying all people at risk for developing or continuing substance use during pregnancy.

			People with psychiatric comorbidities are at a higher risk of using multiple substances during pregnancy. A study on the results of the National Survey of Drug Use and Health (NSDUH) showed that people who experienced a major depressive episode within the last year were more likely to engage in alcohol and tobacco use during pregnancy when compared to pregnant people who abstained from substances. <ref>https://www.ncbi.nlm.nih.gov/books/NBK542330/</ref> The study also found that environmental stressors and lack of consistent prenatal care were correlated with worsening maternal and fetal outcomes. <ref>https://www.ncbi.nlm.nih.gov/books/NBK542330/</ref> The World Health Organization (WHO) recommends engaging people in prevention efforts to improve mental health before becoming pregnant since mental health issues are a risk factor for developing a substance use disorder. <ref>https://www.ncbi.nlm.nih.gov/books/NBK542330/</ref>

	'''Ethical Considerations (Privacy versus Safety).'''		'''Ethical Considerations (Privacy versus Safety).'''
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	The goal of SBIRT is to identify individuals who are unaware that their behaviors are putting them at risk for developing more serious issues. With feedback and support from medical providers, these individuals have the opportunity to make an informed decision and change their current behavior or to seek treatment if needed. If a patient is deemed “moderate” or “high risk” or having “problematic use” the provider can provide a brief intervention and referral for treatment. SBIRT can be implemented with minimal time and effort on behalf of the provider. The impact SBIRT has on the patient is invaluable and helps to connect patients who need education and referral to treatment. <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref>		The goal of SBIRT is to identify individuals who are unaware that their behaviors are putting them at risk for developing more serious issues. With feedback and support from medical providers, these individuals have the opportunity to make an informed decision and change their current behavior or to seek treatment if needed. If a patient is deemed “moderate” or “high risk” or having “problematic use” the provider can provide a brief intervention and referral for treatment. SBIRT can be implemented with minimal time and effort on behalf of the provider. The impact SBIRT has on the patient is invaluable and helps to connect patients who need education and referral to treatment. <ref>https://www.councilsepa.org/programs/screening-brief-intervention-and-referral-to-treatment-sbirt/about-screening-brief-intervention-and-referral-to-treatment-sbirt/</ref>

	~~'''Who is at Risk?'''~~

	Women who were exposed to adverse childhood experiences (ACEs) and are socioeconomically vulnerable have a greater risk of using illicit substances, tobacco, and alcohol. <ref>https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03591-1</ref> White pregnant people are more likely to use tobacco when compared to black and Hispanic populations. <ref>https://www.samhsa.gov/data/sites/default/files/Spot062PregnantRaceEthnicity2012/Spot062PregnantRaceEthnicity2012.pdf</ref> During pregnancy, Black people are more likely to use illicit substances when compared to Hispanics and white people. This data shows that prenatal substance use is present among multiple races and ethnicities. Therefore, medical providers and public health professionals should intervene by identifying all people at risk for developing or continuing substance use during pregnancy.

	People with psychiatric comorbidities are at a higher risk of using multiple substances during pregnancy. A study on the results of the National Survey of Drug Use and Health (NSDUH) showed that people who experienced a major depressive episode within the last year were more likely to engage in alcohol and tobacco use during pregnancy when compared to pregnant people who abstained from substances. <ref>https://www.ncbi.nlm.nih.gov/books/NBK542330/</ref> The study also found that environmental stressors and lack of consistent prenatal care were correlated with worsening maternal and fetal outcomes. <ref>https://www.ncbi.nlm.nih.gov/books/NBK542330/</ref> The World Health Organization (WHO) recommends engaging people in prevention efforts to improve mental health before becoming pregnant since mental health issues are a risk factor for developing a substance use disorder. <ref>https://www.ncbi.nlm.nih.gov/books/NBK542330/</ref>

	= Relevant Research =		= Relevant Research =

BasilSavitsky: /* Key Information */

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Key Information

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	'''Ethical Considerations (Privacy versus Safety).'''		'''Ethical Considerations (Privacy versus Safety).'''
	There is debate among providers of various professions as to whether substance use screening should be universal in prenatal care. Early detection and treatment is critical to protecting the health of both the baby and the mother. However, the fact that many states make prenatal substance use a punitive offense can cause people to avoid seeking prenatal care, which is detrimental in its own right. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> There are substantial barriers to prenatal substance abuse treatment which have lasting consequences for the mother and baby. Since 2000, the number of states that criminalize prenatal substance use has more than doubled, with 25 states plus D.C. classifying it as child abuse, and the same amount has medical reporting requirements. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> These laws had the intention of deterring prenatal substance use, but have instead had severe adverse effects. With so few states offering pre-or postnatal drug treatment programs as an alternative to prosecution due to liability issues, many mothers have instead reported self-isolation and avoidance of both prenatal medical appointments and substance use treatments. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> Substance-using pregnant people who do receive prenatal care experience more positive birth outcomes and have greater opportunities for other health-promoting interventions than people who do not receive care. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> However, the majority of pregnant substance-using people who receive appropriate care and intervention are older, white, and with private health insurance that are less likely to be reported, creating significant disparities. people who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek out treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> This lack of medical care and intervention of untreated prenatal substance use can lead to a greater likelihood of fetal substance dependency and ensuing fetal medical complications.		There is debate among providers of various professions as to whether substance use screening should be universal in prenatal care. Early detection and treatment is critical to protecting the health of both the baby and the mother. However, the fact that many states make prenatal substance use a punitive offense can cause people to avoid seeking prenatal care, which is detrimental in its own right. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> There are substantial barriers to prenatal substance abuse treatment which have lasting consequences for the mother and baby. Since 2000, the number of states that criminalize prenatal substance use has more than doubled, with 25 states plus D.C. classifying it as child abuse, and the same amount has medical reporting requirements. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> These laws had the intention of deterring prenatal substance use, but have instead had severe adverse effects. With so few states offering pre-or postnatal drug treatment programs as an alternative to prosecution due to liability issues, many mothers have instead reported self-isolation and avoidance of both prenatal medical appointments and substance use treatments. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> Substance-using pregnant people who do receive prenatal care experience more positive birth outcomes and have greater opportunities for other health-promoting interventions than people who do not receive care. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> However, the majority of pregnant substance-using people who receive appropriate care and intervention are older, white, and with private health insurance that are less likely to be reported, creating significant disparities. people who use substances while pregnant have a great fear and mistrust of medical and treatment providers because of the risk of reporting, prosecution, and infant displacement. Those who are marginalized and do seek out treatment have little success, as their honesty often leads to criminal reporting or they are unable to find available and affordable treatment programs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> This lack of medical care and intervention of untreated prenatal substance use can lead to a greater likelihood of fetal substance dependency and ensuing fetal medical complications.

	There is a lot of debate among providers of various professions as to whether substance use screening should be universal in prenatal care. Early detection and treatment is critical to protecting the health of both the baby and the mother. However, the fact that many states make prenatal substance use a punitive offense can cause people to not seek prenatal care, which is detrimental in its own right. <ref>https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> This lack of medical care and intervention of untreated prenatal substance use can lead to a greater likelihood of fetal substance dependency and ensuing fetal medical complications.

	'''Primary Prevention'''		'''Primary Prevention'''

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Key Information

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 '''Risk Factors.'''
-While substance abuse occurs within every demographic, there are certain risk factors that create vulnerability for use during pregnancy. It is important to note that demographic data collection is scarce, should be taken as a “minimum” amount, and is highly biased based on policies that disproportionately threaten women of color, low socioeconomic status, and young age. Most available data are taken from enacted policies, discussed below, that are meant to deter prenatal substance use but instead promote maternal prosecution. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.cdc.gov/ncbddd/fasd/features/use-of-other-substances.html</ref> The following categories were derived from non-prosecutorial data and indicate high risk factors for substances during pregnancy: <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref> <ref>https://www-clinicalkey-com.echo.louisville.edu/#!/content/playContent/1-s2.0-S170121631730508X?returnurl=null&referrer=null</ref>
+While substance use occurs within every demographic, there are certain risk factors that create vulnerability for use during pregnancy. It is important to note that demographic data collection is scarce, should be taken as a “minimum” amount, and is highly biased based on policies that disproportionately threaten women of color, low socioeconomic status, and young age. Most available data are taken from enacted policies, discussed below, that are meant to deter prenatal substance use but instead promote maternal prosecution. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.cdc.gov/ncbddd/fasd/features/use-of-other-substances.html</ref> The following categories were derived from non-prosecutorial data and indicate high risk factors for substances during pregnancy: <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.drugpolicyfacts.org/chapter/pregnancy</ref> <ref>https://www-clinicalkey-com.echo.louisville.edu/#!/content/playContent/1-s2.0-S170121631730508X?returnurl=null&referrer=null</ref>
 *ages 15-24
 *education level high school or below
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 *family history of substance use
 *women of color and women on public health insurance had higher rates of prenatal substance use.
 '''Ethical Considerations (Privacy versus Safety).'''

BasilSavitsky: /* Key Information */

2024-12-08T21:37:42Z

Key Information

← Older revision		Revision as of 14:37, 8 December 2024
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	'''Statistical Data.'''		'''Statistical Data.'''
	In order to understand the ~~argument and basis~~ for universal screening for pregnant people, it is vital to know the scope of the problem. The CDC has reported that prenatal substance use is a growing concern, with 10% of pregnant people consuming alcohol regularly and 4.5% partaking in binge drinking. <ref>https://www.cdc.gov/ncbddd/fasd/features/use-of-other-substances.html</ref> The following is a sample of data reflecting the problem of prenatal SUDs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.cdc.gov/ncbddd/fasd/features/use-of-other-substances.html</ref>		In order to understand the case for universal screening for pregnant people, it is vital to know the scope of the problem. The CDC has reported that prenatal substance use is a growing concern, with 10% of pregnant people consuming alcohol regularly and 4.5% partaking in binge drinking. <ref>https://www.cdc.gov/ncbddd/fasd/features/use-of-other-substances.html</ref> The following is a sample of data reflecting the problem of prenatal SUDs. <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.cdc.gov/ncbddd/fasd/features/use-of-other-substances.html</ref>

	*The most common substances used during pregnancy reported by the CDC include opioids, alcohol, marijuana, and tobacco, each carrying its own risks.		*The most common substances used during pregnancy reported by the CDC include opioids, alcohol, marijuana, and tobacco, each carrying its own risks.