ArticleAddiction (Abingdon, England)2019
Accuracy of five self-report screening instruments for substance use in pregnancy.
Article in Addiction (Abingdon, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Can Social Work Interventions Improve Perinatal Mental Health Outcomes? A Systematic Review.Women's health issues : official publication of the Jacobs Institute of Women's HealthPooled it
- Association of prenatal exposure to opioids, cannabis, and polysubstance use with cord blood DNA methylation patterns in a multiancestry cohort.Epigenetics · 2026Article
- Evaluating the implementation of a clinical decision support system for substance use disorder screening in maternal healthcare.Drug and alcohol dependence reports · 2026Article
- Building the mountain mama & baby cohort: study design, protocol, and early prenatal clinic-based recruitment outcomes.American journal of epidemiology · 2026Article
- Substance Use Disorders and the Psychosis Spectrum: Assessment, Clinical Challenges and Management.Journal of clinical medicine · 2026Review
- Talking to Your Patients About Alcohol, Marijuana, and Substance Use During Pregnancy.The primary care companion for CNS disorders · 2025Article
- Article
- Perceptions of positive and negative clinician communication in obstetrical visits from the perspectives of pregnant patients who use substances.PEC innovation · 2025Article
- Status and innovation needed to address health disparities in opioid use disorders among hispanic pregnant individuals.Frontiers in global women's health · 2025Article
- The impact of maternal vulnerability on stress biomarkers and first-trimester growth: the Rotterdam Periconceptional Cohort (Predict Study).Human reproduction (Oxford, England) · 2024Article
- U.S. State rates of newborns reported to child protection at birth for prenatal substance exposure.The International journal on drug policy · 2024Article
- A Comparison of Two Statewide Datasets to Understand Population Prevalence of Substance Use in Pregnancy: Findings and Considerations for Policy & Research.Maternal and child health journal · 2024Article
- Early Insights into Implementation of Universal Screening, Brief Intervention, and Referral to Treatment for Perinatal Substance Use.Maternal and child health journal · 2023Article
- Polysubstance Use in Pregnancy: Surveillance, Interventions, and Next Steps.Journal of women's health (2002) · 2023Review
- Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives.International journal of mental health and addiction · 2023Article
- Principles of care for pregnant and parenting people with substance use disorder: the obstetrician gynecologist perspective.Frontiers in pediatrics · 2023Review
- Saving time, signaling trust: Using the PROMOTE self-report screening instrument to enhance prenatal care quality and therapeutic relationships.PEC innovation · 2022Article
- Association of Prepregnancy Substance Use and Substance Use Disorders with Pregnancy Timing and Intention.Journal of women's health (2002) · 2022Article
- Opioid use in pregnancy: An emerging health crisis.Obstetric medicine · 2021Review
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8 authors.
Funding
Abstract
BACKGROUND AND
aimsThe accuracy of current screening instruments for identification of substance use in pregnancy is unclear, particularly given methodological shortcomings in existing research. This diagnostic accuracy study compared five existing instruments for ability to identify illicit drug, opioid and alcohol use, under privacy expectations consistent with applied practice and using a gold standard incorporating toxicological analysis.
designProspective cross-sectional screening accuracy study.
settingThree sites encompassing four prenatal care clinics in the United States.
participantsConvenience sample of 1220 racially, ethnically and socio-economically diverse pregnant women aged 18 years and over. MEASUREMENTS: In Phase I, participants completed the five screening instruments in counterbalanced order. Instruments included the Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT (acronym for five-item screener with items related to car, relax, alone, forget, friends and trouble), 5Ps (parents, peers, partner, pregnancy, past), Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (NIDA) Quick Screen. In Phase II, participants provided a urine sample and completed a calendar recall-based interview regarding substance use. These screeners were tested, using receiver operating characteristic (ROC) analysis and accuracy statistics, against a reference standard consisting of substance use in three classes (illicit drugs, opioids and alcohol), considered positive if use was evident via 30-day calendar recall or urine analysis.
findingsThree hundred and fifteen of 1220 participants (26.3%) met reference standard criteria for positivity. The single-item screening questions from the NIDA Quick Screen showed high specificity (0.99) for all substances, but very poor sensitivity (0.10-0.27). The 5Ps showed high sensitivity (0.80-0.88) but low specificity (0.35-0.37). The CRAFFT, SURP-P and 5Ps had the highest area under the curve (AUC) for alcohol (0.67, 0.66 and 0.62, respectively), and the WIDUS had the highest AUC for illicit drugs and opioids (0.70 and 0.69, respectively). Performance of all instruments varied significantly with race, site and economic status.
conclusionsOf five screening instruments for substance use in pregnancy tested (Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT, 5Ps, Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (Quick Screen), none showed both high sensitivity and high specificity, and area under the curve was low for nearly all measures.
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