Racial inequities identified in newborn drug testing

Key Takeaways:

• More newborn drug tests were ordered for Black than for white babies (7.3% vs. 1.9%) between 2014 and 2020.
• Testing rate disparities were similar before and after the state legalized recreational marijuana use.
• Test results were more likely to be positive for THC after legalization.

Newborn drug testing for low-risk patients was ordered by clinicians more frequently for Black vs. white newborns both before and after legalization of recreational cannabis use, according to data published in JAMA Network Open.

“Increasing rates of cannabis use may expose more parents to criminalization of a behavior that is now legal in many states and exacerbate existing racial disparities, but there are no studies investigating racial bias in newborn drug testing before and after recreational cannabis legalization,” Sebastian Schoneich, MD, of the department of family medicine at the University of Michigan, Ann Arbor, and colleagues wrote.

In this retrospective cohort study conducted from 2014 to 2020, researchers evaluated 26,366 live births from 21,648 birthing individuals (mean age, 30.5 years) who received prenatal care in the midwestern United States. Overall, 71.6% of birthing parents were white, 93.1% were non-Hispanic and 74.8% had private insurance coverage.

The primary outcome was a newborn drug testing order. Secondary outcomes included any substances identified.

Overall newborn drug testing order incidence was 4.7%, with more tests ordered for Black compared with white newborns (7.3% vs. 1.9%; P < .001) when the birthing parent had no prenatal urine drug test. Researchers identified only THC in 43.3% of the newborn drug tests. Newborn drug tests had a higher likelihood of testing positive for THC among Black compared with white newborns (67.2% vs. 51.8%; P < .001). In addition, newborn drug tests had a higher likelihood of testing positive for opioids among white compared with Black newborns (22.2% vs. 9.4%; P < .001).

After recreational cannabis legalization in 2018, researchers observed consistent differences in newborn drug testing with a higher likelihood of testing positive for THC after compared with before legalization (68.9% vs. 50.3%; P < .001). There were no significant interactions with racial and ethnic groups.

“We view overtesting of Black newborns as a legacy of the culture of white supremacy in reproductive health care in which the conduct of Black women, specifically regarding prenatal substance exposure, is criminalized via the Child Protective Services system,” the researchers wrote. “Our findings strongly suggest that changes in policies regarding drug testing and reporting at the hospital and state level and improvement measures focused on the health, wellbeing, and dignity of Black birthing people are needed to reduce health inequity for Black parents and their newborns.”