title: Perinatal Illicit Drug and Marijuana Use.
abstract: OBJECTIVE
  To assess use, screening, and disclosure of perinatal marijuana and other illicit drugs during first obstetric visits.
  
  
  METHODS
  Observational study that qualitatively assesses provider screening and patient disclosure of substance use.
  
  
  METHODS
  Study sites were five urban outpatient prenatal clinics and practices located in Pittsburgh, Pennsylvania.
  
  
  METHODS
  Pregnant patients and obstetric providers were recruited as participants.
  
  
  METHODS
  We audio recorded patient-provider conversations during first obstetric visits and obtained patient urine samples for drug analyses. Audio recordings were reviewed for provider screening and patient disclosure of illicit drug use. Urine analyses were compared with audio recordings to determine disclosure.
  
  
  RESULTS
  Four hundred and twenty-two pregnant patients provided complete audio recordings and urine samples for analyses. Providers asked about illicit drug use in 81% of the visits. One hundred twenty-three patients (29%) disclosed any current or past illicit drug use; 48 patients (11%) disclosed current use of marijuana while pregnant. One hundred and forty-five samples (34%) tested positive for one or more substances; marijuana was most commonly detected (N = 114, 27%). Of patients who tested positive for any substance, 66 (46%) did not disclose any use; only 36% of patients who tested positive for marijuana disclosed current use.
  
  
  CONCLUSIONS
  Although marijuana is illegal in Pennsylvania, a high proportion of pregnant patients used marijuana, with many not disclosing use to their obstetric care providers.
authors.affiliation: 1 Department of Obstetrics, Gynecology and Reproductive Sciences and General Internal Medicine, Magee-Womens Research Institute, and the Center for Research in Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Judy C
authors.initials: JC
authors.lastname: Chang
authors.affiliation: 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, Pennsylvania.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Holland
authors.affiliation: 2 Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, Pittsburgh, Pennsylvania.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Tarr
authors.affiliation: 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Doris
authors.initials: D
authors.lastname: Rubio
authors.affiliation: 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|5 Center for Health Equity Research & Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Keri L
authors.initials: KL
authors.lastname: Rodriguez
authors.affiliation: 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kraemer
authors.affiliation: 4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Nancy
authors.initials: N
authors.lastname: Day
authors.affiliation: 3 Division of General Internal Medicine, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|6 Institute to Enhance Palliative Care, and Director, Pittsburgh, Pennsylvania.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D005260:Female; D006801:Humans; D002189:Marijuana Abuse / Q000150:complications / Q000453:epidemiology*; D008403:Mass Screening; D010414:Pennsylvania / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D015995:Prevalence; D012650:Self Disclosure; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology*
keywords: Communication; Health focus: illicit drug use; Marijuana; Outcome measure: behavioral; Physician Counseling; Pregnant Women; Prenatal Care; Prevention Research. Manuscript format: research; Research purpose: descriptive; Setting: outpatient obstetrics clinics and offices; Strategy: patient-provider screening communication; Study design: qualitative; Target population age: adult reproductive-age women (18 to 44 years); Target population circumstances: pregnant women and obstetric care providers