UCSF

Purpose: To explore pregnant women’s acceptability of alcohol, tobacco, and drug use screening and willingness to disclose their use in prenatal care. This research explores seeks to center the voices of pregnant women who are directly impacted by the adverse consequences of screening as central to informing the policies and practices that directly impact them, their health and wellbeing, the care they receive, and the formation of their families.

Methods: This thesis is a secondary analysis of self-administered iPad surveys and in-clinic structured interviews with 589 pregnant women aged 18 and older, recruited at their first prenatal care visit from four university-affiliated prenatal care facilities in Baltimore, Maryland and Southern Louisiana. Data were analyzed for associations between outcome variables (acceptability of screening and willingness to disclose use) and predictor variables (substance use, previous CPS involvement, and participant characteristics) using Pearson’s chi-squared tests and Fisher’s exact tests.

Results: A substantial majority of pregnant women found screening acceptable for alcohol (97%), tobacco (98%), and drug use (97%) during prenatal care. Screening for alcohol use was more unacceptable among women who did not report risky alcohol use compared to women who did report risky alcohol use (P = 0.08). Tobacco use, drug use, and previous CPS involvement were not associated with acceptability of screening. A substantial majority of pregnant women reported they are willing to honestly disclose alcohol (99%), tobacco (99%), and drug use (98%). Alcohol, tobacco, and drug use and prior CPS involvement were not associated with the willingness to disclose substance use.

Conclusion: Pregnant women, including those who reported substance use or prior CPS involvement, found substance use screening in prenatal care acceptable and were willing to honestly disclose their use. In general, women with historical and cultural privilege (white, older, with self- or employment-based insurance) were less willing to honestly disclose their alcohol, tobacco, and drug use. These findings are significant as they challenge widely held perceptions of pregnant women who use drugs, and suggest that verbal screening is acceptable as a means of assessing substance use in prenatal care.