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The impact of an obstetric substance use screening and biologic testing protocol on neonatal drug testing

Journal of Perinatology (2026)Cite this article

Subjects

Abstract

Objective

Substance use during pregnancy may affect fetal development and have implications for newborn, childhood, and life-long health. While standardized maternal screening protocols may reduce testing disparities, there are limited data describing the effects of standardized drug screening protocols on neonatal outcomes.

Study design

We conducted a retrospective cohort study of deliveries at a tertiary care center during pre-(7/1/2020–6/9/2021) and post-intervention(6/10/2021–5/31/2022) periods around implementation of a standardized obstetric substance use screening/testing protocol. Associations between neonatal testing and maternal race, ethnicity, and insurance status were assessed using generalized estimating equations (SAS 9.4,α = 0.05).

Result

Among 3163 pre-intervention and 3389 post-intervention neonates, testing decreased post-intervention (4.5% vs. 6.2%, p = 0.0035), though a higher proportion lacked corresponding maternal tests (70.8% vs. 32.3%, p < 0.001). Black neonates had higher testing odds, which attenuated after adjusting for insurance status.

Conclusion

Use of a maternal screening protocol was associated with a reduction in neonatal testing, but disparities persist, warranting further study.

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Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The Duke Biostatistics, Epidemiology, and Research Design (BERD) Methods Core’s support of this project was made possible in part by CTSA Grant (UL1TR002553) from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Funding

This work was supported by the Charles B. Hammond Research Fund, Duke University School of Medicine, Durham, NC.

Author information

Authors and Affiliations

  1. Duke University School of Medicine, Durham, NC, USA

    Adwoa A. Baffoe-Bonnie

  2. Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA

    Siera Bethell, Janea Cato, Lena Fried & Sarahn M. Wheeler

  3. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA

    Leyi Sun & Tracy Truong

  4. Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA

    Yasmeen Midgette & Lakshmi Katakam

  5. Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA

    Jennifer JM Cate

Authors
  1. Adwoa A. Baffoe-Bonnie
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  2. Siera Bethell
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  3. Janea Cato
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  4. Lena Fried
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  5. Leyi Sun
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  6. Tracy Truong
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  7. Yasmeen Midgette
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  8. Lakshmi Katakam
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  9. Sarahn M. Wheeler
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  10. Jennifer JM Cate
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Contributions

ABB conceptualized the study, performed data collection and chart review, drafted the initial manuscript, and led manuscript revision and editing. SB, JC, and LF contributed to data collection and chart review. LS and TT conducted the statistical analysis and contributed to data interpretation. YM and LK provided critical review and revision of the manuscript. SMW and JJMC provided study supervision and contributed to manuscript editing. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Adwoa A. Baffoe-Bonnie.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All methods were performed in accordance with the relevant guidelines and regulations and the principles of the Declaration of Helsinki. This study was reviewed and approved by the Duke University Institutional Review Board (protocol number: Pro00109350). The requirement for informed consent was waived by the ethics committee due to the retrospective nature of the study.

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Baffoe-Bonnie, A.A., Bethell, S., Cato, J. et al. The impact of an obstetric substance use screening and biologic testing protocol on neonatal drug testing. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02598-w

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