Abstract
Mental health conditions including substance use disorder are the leading cause of pregnancy-related deaths in the U.S. Unfortunately, fears of child protective services’ involvement interfere with maternal self-disclosure of substance use in pregnancy. Seeking to identify more mothers with substance use disorder in pregnancy or at delivery, and responsive to changes to the federal Child Abuse Prevention and Treatment Act (CAPTA), Connecticut requires hospital personnel to submit a deidentified notification to CPS for all newborns with prenatal substance exposure. However, it is unknown whether this approach aligns with maternal self-report on substance use. For the present study, we compared population parameters derived from CAPTA notifications submitted between March-December 2019 with parameters derived from self-report data on substance use in pregnancy from mothers who gave birth during the same timeframe. Results revealed that three times as many mothers self-reported any alcohol or drug use in pregnancy compared to the rate measured with CAPTA notifications. Compared to mothers who self-reported drug use in the third trimester, CAPTA notifications were made for statistically similar rates of Black mothers but half the self-reported rate of White and Hispanic mothers. This disparity reflects that CAPTA notifications were made for twice as many Black mothers as White or Hispanic. Although CAPTA notifications are not punitive in nature, this disparity reveals that the public health aims of this policy are not yet achieved.
Significance
Accurate and equitable identification of infants with prenatal substance exposure and their mothers, coupled with non-stigmatized, non-punitive intervention is central to any public health response.The current study relies on 2019 data from Connecticut to understand accuracy and equity in identification of these infants by comparing hospital-based notifications to self-report substance use in pregnancy. We found that hospital approaches to detecting prenatal substance exposure identified twice as many Black mothers as White or Hispanic mothers. Compared to self-reported substance use in pregnancy, which detected equivalent rates of substance use across race groups, White and Hispanic mothers’ substance use in pregnancy was under-identified in hospital settings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
Data subject to third-party restrictions.
References
Bada, H. S., Bann, C. M., Whitaker, T. M., Bauer, C. R., Shankaran, S., LaGasse, L., & Higgins, R. (2012). Protective factors can mitigate behavior problems after prenatal cocaine and other drug exposures. Pediatrics, 130(6), e1479–e1488. https://doi.org/10.1542/peds.2011-3306
Behnke, M., & Smith, V. C. (2013). Prenatal substance abuse: Short-and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009–e1024.
Chasnoff, I. J., Barber, G., Brook, J., & Akin, B. A. (2018). The child abuse prevention and treatment act: Knowledge of health care and legal professionals. Child Welfare, 96(3), 41–58.
Chasnoff, I. J., Landress, H. J., & Barrett, M. E. (1990). The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County. Florida. New England Journal of Medicine, 322(17), 1202–1206.
Deutsch, S. A., Donahue, J., Parker, T., Hossain, J., & De Jong, A. (2020). Factors associated with child-welfare involvement among prenatally substance-exposed infants. The Journal of Pediatrics, 222, 35-44.e31. https://doi.org/10.1016/j.jpeds.2020.03.036
Donohue, B., Holland, J. M., Lopez, K., Urgelles, J., & Allen, D. N. (2014). Examination of illicit drug use frequency using multiple drug assessment methods in mothers referred to treatment by child protective services. Journal of Family Violence, 29(8), 911–919. https://doi.org/10.1007/s10896-014-9646-x
Forde, A. T., Crookes, D. M., Suglia, S. F., & Demmer, R. T. (2019). The weathering hypothesis as an explanation for racial disparities in health: a systematic review. Annals of Epidemiology, 33, 1–18.
Gosdin, L. K., Deputy, N. P., Kim, S. Y., Dang, E. P., & Denny, C. H. (2022). Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years—United States, 2018–2020. MMWR. Morbidity and mortality weekly report, 71(1), 10–13. https://doi.org/10.15585/mmwr.mm7101a2
Green, T. L., Zapata, J. Y., Brown, H. W., & Hagiwara, N. (2021). Rethinking bias to achieve maternal health equity: Changing organizations. Not Just Individuals. Obstetrics and Gynecology, 137(5), 935–940. https://doi.org/10.1097/AOG.0000000000004363
Greenland, S., Senn, S. J., Rothman, K. J., Carlin, J. B., Poole, C., Goodman, S. N., & Altman, D. G. (2016). Statistical tests, P values, confidence intervals, and power: A guide to misinterpretations. European Journal of Epidemiology, 31(4), 337–350. https://doi.org/10.1007/s10654-016-0149-3
Hasan, R. (2020). Six months into child abuse prevention and treatment act (CAPTA): A survey of connecticut hosptial based women’s health. (Master of Public Health). Univeristy of Connecticut.
Hasan, R. (2020). Six months into child abuse prevention and treatment act (CAPTA): A survey of CT hosptial based women’s health (Master of Public Health). Univeristy of CT.
Lloyd, M. H., Luczak, S., & Lew, S. (2019). Planning for safe care or widening the net?: A review and analysis of 51 states’ CAPTA policies addressing substance-exposed infants. Children and Youth Services Review, 99, 343–354. https://doi.org/10.1016/j.childyouth.2019.01.042
Lloyd Sieger, M. H., Nichols, C., Chen, S., Sienna, M., & Sanders, M. (2022). Novel implementation of state reporting policy for substance-exposed infants. Hospital Pediatrics. https://doi.org/10.1542/hpeds.2022-006562
Lloyd Sieger, M. H., Rebbe, R., & Patrick, S. W. (2021). The 2021 reauthorization of CAPTA—letting public health lead. New England Journal of Medicine, 385(18), 1636–1639. https://doi.org/10.1056/NEJMp2111378
NguemeniTiako, M. J., & Sweeney, L. (2021). The government’s involvement in prenatal drug testing may be toxic. Maternal and Child Health Journal. https://doi.org/10.1007/s10995-020-03110-2
Ondersma, S. J., Chang, G., Blake-Lamb, T., Gilstad-Hayden, K., Orav, J., Beatty, J. R., & Yonkers, K. A. (2019). Accuracy of five self-report screening instruments for substance use in pregnancy. Addiction, 114(9), 1683–1693. https://doi.org/10.1111/add.14651
Patel, E., Bandara, S., Saloner, B., Stuart, E. A., Goodman, D., Terplan, M., & McGinty, E. E. (2021). Heterogeneity in prenatal substance use screening despite universal screening recommendations: Findings from the pregnancy risk assessment monitoring system, 2016–2018. American Journal of Obstetrics & Gynecology MFM, 3(5), 100419. https://doi.org/10.1016/j.ajogmf.2021.100419
Perlman, N. C., Cantonwine, D. E., & Smith, N. A. (2021). Toxicology testing in a Newborn ICU: does social profiling play a role? Hospital Pediatrics, 11(9), e179–e183. https://doi.org/10.1542/hpeds.2020-005765
Ramos, A. M., Marceau, K., Neiderhiser, J. M., De Araujo-Greecher, M., Natsuaki, M. N., & Leve, L. D. (2020). Maternal consistency in recalling prenatal experiences at 6 months and 8 years postnatal. Journal of Developmental & Behavioral Pediatrics, 41(9), 698–705.
Rebbe, R., Mienko, J. A., Brown, E., & Rowhani-Rahbar, A. (2019a). Child protection reports and removals of infants diagnosed with prenatal substance exposure. Child Abuse and Neglect, 88, 28–36. https://doi.org/10.1016/j.chiabu.2018.11.001
Rebbe, R., Mienko, J. A., Brown, E., & Rowhani-Rahbar, A. (2019b). Hospital variation in child protection reports of substance exposed infants. The Journal of Pediatrics, 208, 141-147.e142. https://doi.org/10.1016/j.jpeds.2018.12.065
Roberts, S. C., & Nuru-Jeter, A. (2011). Universal alcohol/drug screening in prenatal care: a strategy for reducing racial disparities? Questioning the assumptions. Maternal and child health journal, 15, 1127–1134.
Substance Abuse and Mental Health Services Administration. (2020). 2019 National Survey on Drug Use and Health: Women. In: Department of Health and Human Services.
Trost, S., Beauregard, J., Chandra, G., Njie, F., Berry, J., Harvey, A., & Goodman, D. (2022). Pregnancy-related deaths: Data from maternal mortality review committees in 36 US states, 2017-2019. Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022.
Acknowledgements
CAPTA data were provided by the Connecticut Department of Children & Families (DCF) Information Systems from the DCF’s data system(s). DCF specifically disclaims responsibility for any analyses, interpretations or conclusions. PRAMS and Vital Records data were provided by the DPH. We also thank Katharyn Baca from the Maternal and Child Health Epidemiology Program, Field Support Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Public Health Promotion, Centers for Disease Control and Prevention for assisting with analyses on this project. The PRAMS Working Group membership list can be found here: https://www.cdc.gov/prams/prams-data/PRAMS-working-group.htm. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the CDC or HRSA.
Funding
This work was supported by the Connecticut Department of Children and Families with flowthrough funding from the Administration for Children, Youth, & Families CAPTA Grants (Grant#20DCF2032). Funding for the research and manuscript writing was also provided by NIDA (K01DA058060; Lloyd Sieger, PI). The Connecticut Pregnancy Risk Assessment Monitoring System (PRAMS) is supported by funding from the Centers for Disease Control and Prevention (CDC) (Grant#6U01DP006193) and the Health Resources and Services Administration (HRSA) (Grant#H18MC00007).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical Approval
This article contains research using administrative data. All research activities were approved by the University of Connecticut Institutional Review Board (CAPTA data) and the UCONN Health Institutional Review Board (PRAMS data). All study procedures in this study were in accordance with the ethical standards of the respective IRB.
Informed Consent
Not available.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Sieger, M.L., Morin, J.C., Budris, L.M. et al. A Comparison of Two Statewide Datasets to Understand Population Prevalence of Substance Use in Pregnancy: Findings and Considerations for Policy & Research. Matern Child Health J (2024). https://doi.org/10.1007/s10995-024-03914-6
Accepted:
Published:
DOI: https://doi.org/10.1007/s10995-024-03914-6