Enhanced Substance Use Screening in the Prenatal Clinic

Abstract

Increasing prevalence of substance use among pregnant women exists in the U.S. During pregnancy, screening may identify substance use earlier in order to initiate interventions that impact the lives of mothers and their unborn children. This study investigates the use of a screening tool’s effectiveness in identifying women affected by antenatal substance use to provide for early treatment and referral.

The American Congress of Obstetrics and Gynecology (ACOG) recommends screening every pregnant woman for substance use as part of a thorough obstetrical history.1 ACOG also supports the use of the 4Ps Tool, a valid and reliable instrument used to identify women at risk from any level of alcohol or illicit drug use.2,3 The 4 Ps tool—a 4-item survey of a) current use in Pregnancy; b) Past use; c) history of Partner; and d) Parental use—may be completed within the constraints of an outpatient obstetrical visit.4

A quality improvement (QI) project was implemented in a private practice during spring 2018 using Pender’s Health Promotion and PDSA models. Staff were educated on maternal and fetal risks of substance use and trained on the use of the 4Ps tool. Tools were evaluated at point of care with appropriate recommendations made for treatment or referral during same visit.

Of 164 patients presenting for routine care, 66% were screened using the 4Ps tool. The women were White (95%), Asian (1%), and Other (4%). Women reported past use of alcohol or substances (11%), having smoked cigarettes (15 %), and drank alcohol/used substances within the month before pregnancy was confirmed (13%). Pregnant women also identified having a parent (12%) or partner (4%) with alcohol or drug problem. Women who screened positive (n= 37) were offered supportive services via community resources and/or treatment referrals per protocol. Retrospective chart audits revealed 57% of women who screened positive accepted referral services.

Improved substance use screening allows the provider to offer supportive services in a timely manner to promote long-term abstinence. Use of a validated screening tool provides opportunity to open discussions with mothers regarding negative impacts of substance use on the health of their unborn child.