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Clinical Obstetrics

Poster Session 1

(324) Assessing Provider Confidence in Counseling Patients about Peripartum Toxicology Testing

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Molly R. Siegel, MD

Massachusetts General Hospital
Boston, MA, United States

Coauthor(s)

SB

Sabine Berry, N/A

Massachusetts General Hospital, Department of Obstetrics and Gynecology
Boston, MA, United States
SB

Sarah N. Bernstein, MD

Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology
Massachusetts General Hospital
Boston, MA, United States

Objective: To evaluate provider comfort in discussing peripartum toxicology testing with patients.

Study Design: Semi-structured virtual interviews were performed with a convenience sample of obstetric providers in a single hospital system. Interviews assessed provider comfort with consenting for testing, disclosing toxicology test results, reviewing implications for maternal and infant health, and referring to treatment. Responses were assessed using descriptive statistics.

Results: Of 20 participants, 5 (25%) were trainees, 6 (30%) were attending midwives, and 11 (55%) were attending obstetricians. 10 (50%) had been in practice for at least 10 years. Most participants reported that they counsel patients about substance use in pregnancy less than once per week (15/20, 75%), and 6/20 (30%) of participants reported that they do not always obtain consent before toxicology testing in pregnancy, despite a hospital policy and the United States Supreme Court ruling requiring such consent. While participants expressed high confidence in counseling peripartum patients on the implications of positive toxicology test results on neonatal health, only half reported that they understood the implications of a positive test on maternal health and breastfeeding or that they understood the treatment options available to patients with a positive toxicology test (Figure). Only two participants (10%) agreed that they understood and could counsel patients on the implications of a positive toxicology test on child welfare reporting.

Conclusion: Providers expressed low confidence in counseling pregnant patients on the implications of a positive toxicology test for maternal health, breastfeeding, treatment referrals, and child welfare, which may explain the suboptimal rates of providers obtaining consent for toxicology testing in this cohort. Educational initiatives to improve provider comfort with discussing implications of a positive test are imperative and planned by these authors.