Racial Disparities in Urine Toxicology Screening Among Pregnant People Admitted to Labor and Delivery.

Abstract

Disparities in urine toxicology screening (UTS) during labor and delivery may perpetuate healthcare inequities with significant social and legal consequences for minoritized populations. This study examines whether UTS rates during labor and delivery differ by race or ethnicity. A retrospective cross-sectional study was conducted using electronic health record data of labor and delivery admissions between July 1, 2018 and June 30, 2022 from 3 health systems in Minnesota and Wisconsin. Eligible records included labor and delivery admissions for patients aged 12 years and older, resulting in live birth or fetal demise. Patients who opted out of research at the health system level were excluded. Among 71,341 patients (81,999 admissions), most identified as White (66.2%), followed by Black/African American (14.8%), Asian (9.5%), multiracial (2.5%), American Indian or Alaskan Native (0.7%), and other races (1.4%). Hispanic/Latinx patients comprised 6.1%. UTS was ordered in 14.2% of admissions (n=10,176). Compared with White patients, UTS was more likely for Black (aOR=2.09, 95% CI=1.93-2.25), American Indian (aOR=2.50, 95% CI=2.00-3.13), and multiracial patients (aOR=2.04, 95% CI=1.77-2.36), despite similar positive test rates across groups when excluding cannabis/THC. Racial disparities in UTS persist, driven by nonclinical factors and biases, despite similar rates of substance use across groups. Standardized, equitable testing protocols are needed to mitigate harm and improve outcomes for minoritized birthing populations.