Variation in Perinatal Toxicology Testing and Consent Practices Among United States Birthing Hospitals: Results From a National Survey.

BACKGROUND

Professional society guidelines recommend risk-based, consent-informed perinatal toxicology testing, emphasizing its use only when results inform clinical care. How these guidelines are implemented in U.S. hospitals remains unclear.

METHODS

We conducted a cross-sectional survey (July 2023-June 2024) via perinatal quality collaboratives and national professional networks, including one response per hospital. The survey assessed hospital-level practices related to substance use screening, perinatal toxicology testing, and consent procedures. We captured hospital and state characteristics, including cannabis legalization and mandatory reporting laws. Descriptive statistics and multivariable modified Poisson regression models assessed associations between hospital/state characteristics and testing and consent practices.

RESULTS

We received 217 eligible responses from birthing hospitals across 43 states. Most hospitals screened for substance use at delivery (84.8%), although fewer than half used validated screening tools. Written protocols were common (69.1% for birthing person, 73.7% for newborn testing), but informed consent was inconsistently obtained (70.0% for birthing person, 27.8% for newborn testing). Testing was predominantly risk based, although rationales included a range of substance-related, medical, and social factors. Hospitals in states without cannabis legalization were significantly more likely to test for cannabis-related reasons (p < .001). Adjusted models showed regional variation in consent practices and lower odds of written protocols in hospitals serving larger Medicaid populations. Mandatory reporting laws were not significantly associated with testing practices.

CONCLUSIONS

Perinatal toxicology testing practices vary widely and often diverge from professional society recommendations, especially regarding consent and testing rationales. Testing frequently occurs for nonclinical reasons, underscoring the need for standardized, evidence-informed policies that prioritize informed consent.