Over the last 3 decades, use of prescription drugs has increased by more than 60%, and prevalence of prescription drug use among pregnant women is currently estimated around 50%. Children born to women who abuse prescription medications are more likely to be born with neonatal abstinence syndrome, the incidence of which has doubled in the past 5 years. Recent national survey data show that the rate of current illicit drug use is 14.6% among pregnant adolescents, 8.6% among young adults, and 3.2% among adults. The first step in identifying both prescription drug abuse and illicit drug use during pregnancy is screening; however, no specific substance use screener has been recommended for use with pregnant women to identify illicit or prescription drug use. The proposed study will compare and validate three existing substance use screeners - 4 P?s Plus, NIDA Quick Screen/ASSIST, and the Substance Use Risk Profile-Pregnancy scale - among at least 500 pregnant women stratified by trimester of pregnancy presenting to two primary care clinics in Baltimore over 1 year.
Specific aims are to: (1) conduct validity analyses to determine sensitivity, specificity, usability, and how each scale compares to the others and to the gold standard of urine and hair drug testing in identifying prescription and illicit drug use; (2) determine the impact of clinic population variables (age, race, trimester of pregnancy) on validity of the three substance use screeners; and (3) assess birth outcomes (birth weight, gestational age, head circumference, and NICU admissions) associated with the most widely used prescription drug and multi-drug exposure. The end goal of the study is to determine which screening tool(s) is most effective in identifying prescription drug abuse and illicit drug use among pregnant women so that evidence- based guidance may be offered to clinicians, utilizing biochemical drug testing as the gold standard to designate use and electronic medical records (EMR) as a supplement to identify prescribed drugs.
Aim 3 was added to capture the important and relevant associations between the drug use and birth outcomes.
Prescription drug abuse and illicit drug use during pregnancy can lead to multiple health and social problems for both mother and child yet both are often under-recognized in primary care settings, perhaps due to current evidence being insufficient for the United States Preventive Services Task Force to make a screening recommendation. The proposed research will determine which screening measure(s) works best in identifying prescription drug abuse and illicit drug use among pregnant women by utilizing an innovative study design including mixed quantitative and qualitative methods, and will widely disseminate study findings in a variety of settings.
| Oga, Emmanuel A; Mark, Katrina; Coleman-Cowger, Victoria H (2018) Cigarette Smoking Status and Substance Use in Pregnancy. Matern Child Health J : |
| Coleman-Cowger, Victoria H; Oga, Emmanuel A; Peters, Erica N et al. (2018) Comparison and validation of screening tools for substance use in pregnancy: a cross-sectional study conducted in Maryland prenatal clinics. BMJ Open 8:e020248 |
| Coleman-Cowger, Victoria H; Pickworth, Wallace B; Lordo, Robert A et al. (2018) Cigar and Marijuana Blunt Use Among Pregnant and Nonpregnant Women of Reproductive Age in the United States, 2006-2016. Am J Public Health 108:1073-1075 |
| Coleman-Cowger, Victoria H; Oga, Emmanuel A; Peters, Erica N et al. (2018) Prevalence and associated birth outcomes of co-use of Cannabis and tobacco cigarettes during pregnancy. Neurotoxicol Teratol 68:84-90 |
