The Predictive Value of Routine Urine Drug Screening in a High-Risk Obstetric Population

Abstract

This study assesses the incidence of drug usage in our high-risk obstetrical population and correlates these findings to patient history, pregnancy complications, and routine prenatal drug screens. Intrapartum drug screens for cocaine and marijuana metabolites were performed on 466 patients. Prenatal drug screens were available on 269 of these women. Positive cocaine and marijuana screens occurred in 9.6% and 3.6% of intrapartum screens and in 8.6% and 7.4% of prenatal screens, respectively. Positive marijuana screens were not associated with any prenatal risk factor or adverse pregnancy outcome. Intrapartum cocaine use was associated with an increased incidence of absent/poor prenatal care, sexually transmitted disease, preterm rupture of membranes, abruption, and low birth weight. Antenatal cocaine or marijuana use was significantly associated only with low birth weight. A positive prenatal drug screen was associated with a high incidence of a positive intrapartum screen. A majority of complications occurred in patients without prenatal care regardless of drug use. Routine prenatal drug screening may identify women who use cocaine and marijuana, but does not have a significant effect on perinatal morbidity or mortality as those at highest risk often do not present for prenatal care or have negative prenatal screens.

Key Words:

• Drug abuse
• Pregnancy
• Cocaine