Ethan Rhodes
Newborn drug testing is a controversial topic, with racial inequities and varying state legislation further complicating the issue. While no federal guidelines exist for newborn drug screening, medical institutions typically test when risk factors such as maternal substance use disorder are known. In most states, OBGYN physicians and hospital workers are required to report failed drug screens, with alcohol use being less likely to be reported. Marijuana is a controlled substance in Texas, and newborn exposure is considered neglectful supervision, but no woman has been prosecuted solely for drug abuse during pregnancy since 2017. In Illinois, a newborn testing positive for drugs other than marijuana triggers a Department of Children and Family Services investigation. Some hospitals test babies after birth for cannabis exposure, and if they test positive, they may notify Child Protective Services.
| Characteristics | Values |
|---|---|
| Military hospitals test newborns for marijuana | Yes, in some states, hospitals do test newborns for marijuana exposure. |
| Universal newborn drug testing criteria | No federal or society guidelines exist that provide criteria for newborn drug screening. |
| Newborn drug testing methods | Urine, hair, and blood (including umbilical cord blood) tests are used for newborn drug screening. |
| Reporting newborn drug test results | In most states, OBGYN physicians and hospital workers report failed drug screens and suspected drug use of pregnant women to state agencies. |
| Newborn drug testing inequities | Studies have shown that guidelines on what should trigger newborn drug tests are often unclear and inconsistent, contributing to racial inequities in who gets tested. |
| Newborn drug testing and maternal substance use disorder | Medical institutions typically test newborns for drug exposure when risk factors such as a maternal history of substance use disorder are known. |
| Newborn exposure to controlled substances | In Texas, newborn exposure to controlled substances, including marijuana, is counted as neglectful supervision. |
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What You'll Learn
Newborn drug testing and racial inequities
Racial inequities in newborn drug testing have been observed in various studies, with Black newborns facing higher rates of screening compared to other racial groups. This disparity persists even in the absence of risk factors for substance use disorders. The overtesting of Black newborns is attributed to structural racism and obstetric racism, which contribute to the criminalization and policing of Black parents and families.
In a study conducted at the University of Michigan Health, researchers analyzed data from 26,366 births between 2014 and 2020. They found that newborns born to white parents were 24% less likely to undergo drug testing than those from Black families. However, the drug tests of white newborns were more likely to be positive for opioids, indicating potential undertesting and missed opportunities for intervention.
The decision to order a newborn drug test was previously left to the discretion of clinicians, leading to inconsistencies in testing practices. To address this, Michigan Medicine implemented a standardized policy to help clinicians determine when a drug test is warranted. This includes considering symptoms of withdrawal in the newborn or self-reported drug use during pregnancy.
Studies have also examined the role of healthcare professionals (HCPs) and Child Protective Services (CPS) in perpetuating racial inequities. HCPs have been found to lack knowledge about the disproportionate harms of CPS reporting for Black families, contributing to inconsistent hospital policies and the racialized application of state laws. The result is a higher rate of CPS referrals and the surveillance and criminalization of Black parents' drug use.
To reduce health inequity and improve outcomes for Black birthing people and their newborns, policy changes are necessary at the state, community, and hospital levels. This includes addressing implicit bias among healthcare professionals and implementing anti-racist measures to promote health equity. Standardized policies for newborn drug testing can help identify and address racial inequities, ensuring that testing is based on medical criteria rather than racial biases.
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Testing methods and considerations
Newborn drug testing methods vary, and there are no federal or society guidelines that provide criteria for testing. Medical institutions typically test when risk factors such as maternal history of substance use disorder are known. Testing should be considered if there is a patient history of high-risk behaviour, minimal or no prenatal care, or unexplained obstetric events. Testing should also be considered in infants with unexplained neurologic complications, unexpected intrauterine growth restriction, or drug withdrawal symptoms.
The most common specimens used in newborn drug testing are meconium (the first stool of a newborn) and umbilical cord tissue, which are preferred for evaluating chronic exposure. Urine, hair, and blood (including umbilical cord blood) tests are also used, offering different advantages and disadvantages. The time taken to obtain test results can vary depending on several factors, including the timing of sample collection, the proximity of the laboratory performing the test, and the method used for testing.
In most states, OBGYN physicians and hospital workers are required to report failed drug screens and suspected drug use of pregnant women to state agencies. However, guidelines on what should trigger these tests are often unclear and inconsistent, which may contribute to racial inequities in who gets tested. For example, a study at the University of Michigan Health found that newborns born to white parents were 24% less likely to receive a drug test than those in Black families.
After a newborn tests positive for drugs, mandated reporters in many states, including healthcare professionals and social workers, are required to report it to Child Protective Services (CPS). The steps taken by hospitals after a positive drug test may vary, including limiting access to support services and notifying CPS. CPS will then conduct a thorough risk assessment, evaluate the caregiver and home environment, and determine the necessary protective measures. Investigations can be lengthy, and files may remain open for several years.
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Alcohol testing and newborn exposure
Screening for prenatal alcohol exposure is an essential function of primary care and the responsibility of pediatricians. Alcohol use during pregnancy can lead to fetal alcohol spectrum disorders (FASDs), which can cause lifelong physical, emotional, behavioural, and cognitive problems for the child. FASDs can be identified through a combination of maternal self-report and observation of the child's symptoms. Symptoms may include abnormal facial features, small head size, lower than average height and weight, poor coordination, vision and hearing problems, intellectual disabilities, delayed development, and poor social skills.
While there is no single test for FASDs, early identification is critical to the well-being of the child and their family. Screening can be conducted at any family interaction time, including prenatal visits, the newborn period, adoption, and when new patients join a practice or when developmental issues emerge. Obtaining a history of prenatal alcohol exposure should be routine for all pediatric patients, and normalizing conversations about prenatal alcohol use is important.
In addition to maternal self-report, prenatal alcohol exposure can be inferred through other means. For example, if the mother has been arrested or entered an alcohol treatment program during pregnancy, or if the child has been adopted and exhibits symptoms of FASDs. At ARUP Laboratories, a test has been developed that can detect in-utero alcohol exposure by analyzing a snippet of the baby's umbilical cord or meconium (the infant's first stool). This test can provide valuable information for clinicians, allowing them to educate and support the mother and improve the health outcomes of the child.
Newborn drug testing practices have been criticized for contributing to the disproportionate criminalization and policing of Black parents and families. Studies have shown that newborns from Black families are more likely to be drug-tested than those from white families, and efforts are being made to address these inequities through implicit bias training and anti-racism research.
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Marijuana legislation and reporting
In Colorado, some hospitals test babies after birth for exposure to cannabis, and positive test results may lead to limited access to support services and possible notification of Child Protective Services. Michigan has also implemented a new policy to help clinicians determine whether a drug test is warranted, taking into account factors such as the baby showing symptoms of withdrawal or the birthing person's disclosure of drug use during pregnancy.
The lack of standardised guidelines for newborn drug screening at the federal level contributes to inconsistencies in testing criteria and reporting obligations across states and medical institutions. This lack of standardised guidelines has been identified as a contributing factor to racial inequities in newborn drug testing, with studies revealing that newborns from Black families are more likely to be tested than those from white families.
To address these disparities, policy changes have been advocated at the state, community, and hospital levels, emphasising the need to reduce health inequities and improve measures focused on the health, well-being, and dignity of marginalised birthing individuals and their newborns.
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Drug testing and patient history
Drug testing for newborns is a complex and sometimes controversial topic. While there are no federal guidelines or mandates that provide criteria for newborn drug testing, it is typically done when risk factors such as a maternal history of substance use disorder are known or suspected. This includes a documented history of substance use, misuse, or abuse, minimal or no prenatal care, or unexplained obstetric events. Testing may also be considered if the infant shows signs of drug exposure or withdrawal, such as neonatal abstinence syndrome (NAS).
The decision to drug test a newborn can have serious implications for the family, and studies have shown that there are racial inequities in newborn drug testing, with newborns from Black families more likely to be tested than those from white families. This has resulted in the disproportionate criminalization and policing of Black families. To address these inequities, some institutions have implemented policies and training to reduce implicit bias and improve health equity.
The methods used for newborn drug testing are similar to those used for adults, including mass spectrometry (MS) and immunoassay. Specimen types include urine, hair, blood (including umbilical cord blood), meconium (the first stool of a newborn), and umbilical cord tissue, with meconium and umbilical cord tissue preferred for evaluating chronic exposure. The choice of specimen type depends on the window of detection desired and the advantages and disadvantages of each type.
In terms of patient history, a history of substance use disorder or high-risk behaviour would be a factor in deciding to perform a drug test on a newborn. This could include a history of drug use, misuse, or abuse, as well as a lack of prenatal care or unexplained obstetric events. Additionally, a patient's history of compliance with addiction treatment programs can positively impact the outcome of a case and reduce child welfare involvement. Overall, the decision to perform a drug test on a newborn should be made based on the best interests of the child, taking into account the potential risks and benefits of testing.
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Frequently asked questions
Military hospitals do not have a standard policy on newborn marijuana testing. Testing may be conducted based on institutional policies and risk factors such as a maternal history of substance use.
Testing for marijuana exposure in newborns can be triggered by various factors, including a patient history of high-risk behaviour, minimal or no prenatal care, unexplained obstetric events, or infant health complications.
If a newborn tests positive for marijuana, the hospital's response can vary. Possible actions include limiting access to support services and notifying Child Protective Services. The specific steps taken depend on the hospital's policies and the state's legislation.
Legal consequences for marijuana use during pregnancy vary by state. In some states, newborn exposure to marijuana may be considered neglectful supervision, potentially leading to child welfare investigations and possible loss of custody. However, progressive states often focus on providing treatment rather than criminal prosecution.
Yes, studies have shown racial inequities in newborn drug testing, with newborns from Black families more likely to be tested than those from white families. This disparity contributes to the disproportionate criminalization and policing of Black parents and families.
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