Abstract
Objective
To evaluate for disparities in peripartum toxicology testing among maternal-infant
dyads across a hospital network and subsequent child protective services (CPS) involvement.
Methods
Retrospective chart review of 59,425 deliveries at 5 hospitals in Massachusetts between
2016 and 2020. We evaluated associations between maternal characteristics, toxicology
testing, and child welfare involvement with disproportionality risk ratios and hierarchical
logistical regression.
Results
Toxicology testing was performed on 1959 (3.3%) dyads. Younger individuals and individuals
of color were more likely to be tested for cannabis use or maternal medical complications
compared to white non-Hispanic individuals. Among those without a substance use disorder,
age <25 (adjusted odds ratio [aOR] 2.81; 95% confidence interval [CI], 2.43–3.26),
race and ethnicity (non-Hispanic Black (aOR 1.80; 95% CI, 1.52–2.13), Hispanic (aOR
1.23; 95% CI, 1.05–1.45), mixed race/other (aOR 1.40; 95% CI, 1.04, 1.87), unavailable
race (aOR 1.92; 95% CI, 1.32–2.79), and public insurance (Medicaid [aOR 2.61; 95%
CI, 2.27–3.00], Medicare [aOR 13.76; 95% CI, 9.99–18.91]) had increased odds of toxicology
testing compared to older, white non-Hispanic, and privately insured individuals.
The disproportionality ratios in testing were greater than 1.0 for individuals under
25 years old (3.8), Hispanic individuals (1.6), non-Hispanic Black individuals (1.8),
individuals of other race (1.2), unavailable race (1.8), and individuals with public
insurance (Medicaid 2.6; Medicare 10.6). Among dyads tested, race and ethnicity was
not associated with CPS involvement.
Conclusions
Peripartum toxicology testing is disproportionately performed on non-white, younger,
and poorer individuals and their infants, with cannabis use and medical complications
prompting testing more often for patients of color than for white non-Hispanic individuals.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
January 27,
2023
Received:
June 30,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2023 by Academic Pediatric Association
