The effect of implementing a more comprehensive screening for substance use among pregnant women in North Carolina.

OBJECTIVES: Substance use during pregnancy causes significant morbidity and mortality. Screening for substance use provides opportunity for intervention and treatment, but is often overlooked in prenatal care with today's fiscal climate and preconceived ideas about who uses substances. The purpose of this study was to determine the effect of implementing a more comprehensive screening procedure for identifying substance-using pregnant women.
METHODS: Two hundred randomly selected prenatal patients screened using the old procedure for substance use during pregnancy were compared to 400 randomly selected patients screened after implementation of a new, more detailed screening procedure. The old screening approach included three check-boxes concerning substance use during pregnancy: one for "Smoking/alcohol," one for "Drug use (any)," and one for "Drug addiction/alcoholism." The new screening procedure included more detailed questions about the frequency of cigarette, alcohol, and illegal drug use during pregnancy.
RESULTS: Compared with the old approach, the new screening protocol increased reporting of smoking/alcohol use from 21% to 72% (relative risk = 2.63, 95% confidence interval = 2.231, 3.108); reporting of any drug use from 12% to 18% (relative risk = 1.07, 95% confidence interval = 1.002, 1.150); and reporting of alcoholism/drug abuse from 0% to 6% (relative risk = 1.06, 95% confidence interval = 1.038, 1.090).
CONCLUSIONS: Our study suggests that more detailed screening using direct questions concerning the amount and frequency of substance use increases reporting of prenatal substance use as compared to screening approaches using only "yes/no" style check boxes.