Apr 17, 2023 - Health

Study reveals bias in drug testing pregnant patients

Illustration of a machine claw lifting a beaker of red liquid.

Illustration: Lindsey Bailey/Axios

Pregnant Black patients were drug tested more often than white patients before delivery, a JAMA Health Forum analysis of patients in a large Pennsylvania health system from March 2018 to June 2021 found.

  • Black patients were no more likely to test positive for using substances while pregnant, but even those with no history of substance use were asked to get urine toxicology testing more often than other racial groups, the study of more than 37,000 patients found.

Why it matters: Federal and some state laws require providers to report patients to child welfare agencies if their toxicology report reveals substance use.

  • But not applying the practices evenly across groups can amount to medical racism, said Marian Jarlenski, lead researcher and professor at the University of Pittsburgh School of Public Health.

By the numbers: Black patients without a history of substance abuse had a 6.9% mean probability of being drug tested at delivery compared to a 4.7% mean probability for white patients.

  • Among patients with substance use documented in the last year in their electronic health record, Black patients had a 76% mean probability of being drug tested compared to 68% of white patients.
  • Among those patients with a history of substance abuse, the predicted probability of having a positive test result was higher among white pregnant patients than Black patients.

What's next: Legislation pending in California and New York would bar the practice of drug-testing pregnant patients without their explicit consent, unless it is deemed medically necessary for the care of the pregnant person or their infant.

  • Jarlenski said states should instead focus on treatment and incentivize health care systems to make sure people can access treatment, ideally early in their pregnancy.
  • "They have to feel like they can disclose substance use without being penalized or having their kids taken away," Jarlenski told Axios.
  • Some health systems use specific protocols to determine who gets urine testing, including factors like late entry to prenatal care or preterm birth, which disproportionately impact Black women, Sarah Roberts, study author and professor at the University of California San Francisco, wrote in an email to Axios.
  • "Protocols based on factors such as these essentially just institutionalize the racism that exists when providers are left on their own to decide whose urine to test," Roberts said in an email.
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