(263) Variation in Toxicology Testing and Consent Practices Among United States Birthing Hospitals: A National Survey

Current recommendations from professional organizations for ordering and obtaining consent for peripartum toxicology testing remain broad and best practices for both are lacking. We aimed to describe peripartum toxicology testing practices across birthing hospitals in the United States (US).

Study Design: A cross-sectional online survey was distributed through perinatal quality collaboratives, publicly available birthing hospital contacts, and professional organization electronic mailing lists. The survey captured birthing hospital characteristics and toxicology testing practices for both birthing people and neonates, including indication(s) for testing and consent practices. One response per hospital was included in the final analysis. Descriptive statistics were used to analyze responses.

Results: Respondents from 219 birthing hospitals across 42 states were included. 81.7% of hospitals reported risk-based testing, whereas 11.4% reported universal testing. Among hospitals employing a risk-based approach, the most common indications for ordering birthing person toxicology testing at delivery included: 1) disclosure of substance use in current pregnancy (96.6%), 2) positive toxicology test in current pregnancy (91.6%), 3) birthing person with signs of intoxication or withdrawal (89.4%), 4) neonate with signs of withdrawal (83.2%), and 5) late or limited prenatal care (80.4%). 69.4% and 28.3% of hospitals reported obtaining consent for birthing person and neonate toxicology testing, respectively; among hospitals who ordered testing without consent, 42.3% and 28.8% reported lack of disclosure for birthing person and neonate toxicology testing, respectively.

Conclusion: Our data reveal wide variations in toxicology testing and consent practices among US birthing hospitals. Given the unique and potentially harmful consequences of toxicology testing in this setting, clearer guidance from professional organizations is needed on clinically appropriate indications for testing and standardized approaches for obtaining consent.