208 - Maternal Risk Factors Associated with Positive Neonatal Drug Toxicology

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 208
Publication Number: 208.333

Hannah Pee, Maria Fareri Children's Hospital, New York Medical College, New York, NY, United States; Karen Hussein, New York Medical College, Valhalla, NY, United States; Prabhakar Kocherlakota, New York Medical College, Newburgh, NY, United States

Presenting Author(s)

Hannah Pee, MD (she/her/hers)

Neonatal-Perinatal Medicine Fellow, PGY-6
Maria Fareri Children's Hospital, New York Medical College
New York, New York, United States

Background: The incidence of substance use disorder (SUD) during pregnancy is increasing across the country. Infants born to mothers with SUD are associated with short-term and long-term adverse outcomes. There is debate as to whether a risk-based or universal toxicology screening approach is more effective to identify substance abuse in pregnancy. The specific risk factors associated with identifying neonates with in-utero drug exposure are unknown.

Objective: To identify maternal and neonatal risk factors strongly associated with positive neonatal drug toxicology results.

Design/Methods: A retrospective chart review of neonates delivered at Montefiore St. Luke’s Cornwall Hospital in Newburgh, NY, from October 2016 to July 2022 who underwent drug toxicology testing via urine, meconium, and/or umbilical cord samples were included in the study. Toxicology testing was done in infants born to mothers with a history of past or current substance use, history of opioid use disorder (OUD) on medication-assisted treatment (MAT), minimal prenatal care (PNC), incarceration, placental abruption at delivery, or sexually transmitted diseases, and in a neonate with intrauterine growth restriction (IUGR)/small for gestational age(SGA), neonatal abstinence syndrome (NAS) symptoms, or unexpected apnea/stroke. Results were subjected to appropriate statistical analysis.

Results: Of the 538 dyads with risk factors, 268 infants had positive toxicology (Table 1). Self-reported current substance use (63.4%), history of substance use (62.7%), and minimal PNC (54.9%) were common risk factors. (Table 2) Among the risk factors, use of MAT (98.8%), neonate with withdrawal signs (87%), current drug use (80.2%), and history of substance use (73.4%) were more commonly associated with positive toxicology confirmation. Self-reported drug use and MAT had positive associations with neonatal toxicology results, with an odds ratio of 27.3 and 36.7, respectively, by logistic regression analysis (p< 0.001) (Table 3).

Conclusion(s): Self-reported history of substance use and MAT were strongly associated with positive neonatal drug toxicology. Our results suggest that selectively testing mothers without history of use or current use are not effective for detecting in utero drug exposure.