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Neonatal Abstinence Syndrome and Ethical Approaches to the Identification of Pregnant Women Who Use Drugs

Terplan, Mishka MD, MPH; Minkoff, Howard MD

doi: 10.1097/AOG.0000000000001781
Contents: Current Commentary

The United States is experiencing an epidemic of opioid use, addiction, and neonatal abstinence syndrome. Consequentially, a great deal of public, and public health, attention has turned toward the timely recognition of pregnant women who use drugs. We explore the clinical efficacy and ethical acceptability of different methods of identification—contrasting drug testing (using biologic samples such as urine) with screening (using an instrument or questionnaire) under both universal and selective approaches within the current legal and social landscape, which is fraught with potential adverse consequences for both the woman and her child. Unlike other medical conditions such as diabetes, the sequelae of drug use in pregnancy can go beyond the clinical, because its assessment may result in child removal as well as maternal arrest, prosecution, and punishment. Although universal voluntary screening using a validated instrument is the most reasonable public health strategy, physicians should advocate for that only as strongly as they advocate for social support and addiction care services for those subsequently identified.

Physicians should advocate for universal screening, using a validated questionnaire, only as strongly as they advocate for the decriminalization of pregnant women who use drugs.

Behavioral Health System, Baltimore, Maryland; and the Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York.

Corresponding author: Mishka Terplan, MD, MPH, 1 N Charles Street, Suite 1300, Baltimore, MD 21201; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.