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A Comparison of Two Statewide Datasets to Understand Population Prevalence of Substance Use in Pregnancy: Findings and Considerations for Policy & Research

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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.

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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).

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Correspondence to Margaret Lloyd Sieger.

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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.

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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 28, 1121–1131 (2024). https://doi.org/10.1007/s10995-024-03914-6

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