Study: Accuracy of Five Self‐Report Screening Instruments for Substance Use in Pregnancy

June 19, 2019

Nearly one-fourth of pregnant women report having used alcohol, tobacco, or other substances in the past month, yet current screening questionnaires used by physicians may not accurately identify many of them.

Kimberly A. Yonkers, MD, Professor of Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Services at Yale School of Medicine, was the senior researcher among investigators across three universities who compared results of five commonly used questionnaires against laboratory testing. The work was funded by the Centers for Disease Control and Prevention.

“There is a dire need for an accurate and sensitive measure that could help in determining which pregnant women misuse substances and who can benefit from treatment,” Yonkers said.

Reducing substance use during pregnancy can provide health benefits to mothers and their babies. Physicians treating pregnant women need a valid questionnaire to assist them in identifying patients at risk for substance use. While questionnaires have been available, there has been a notable lack of rigorous data comparing them to each other and to laboratory results. This study compared four questionnaires that have had some level of testing in pregnant women and the WHO ASSIST, a global measure that assesses use of a variety of substances in many populations.

“Unfortunately, none of them showed good ability to identify alcohol, illicit drug, or opioid use among pregnant women,” said Steven Ondersma, PhD, of Wayne State University, a member of the research team. The accuracy of these questionnaires varied depending on a variety of factors, such as the woman’s race or ethnicity, or her economic status,” Ondersma said.

The study team was led by Yonkers. The researchers recruited 1,220 pregnant women from the Yale New Haven Health System, the Henry Ford Health System, and Massachusetts General Hospital. Results of the five questionnaires were compared against laboratory screenings.

“We need better ways to identify substance use in pregnancy. Our study shows that part of the solution lies in creating better questionnaires,” Ondersma said. “But identifying risk will continue to be a challenge as long as reporting substance use exposes women to stigma, threatens custody of their baby or puts them at risk of prosecution.”

The study, “Accuracy of Five Self-report Screening Instruments for Substance Use in Pregnancy,” appears in the June 19 issue of the journal Addiction. Yonkers is the senior author. The research was supported by the Centers for Disease Control and Prevention and the Helene Lyacki/Joe Young Sr. Funds from the State of Michigan.

Submitted by Christopher Gardner on June 19, 2019