Underdetection of Substance Abuse

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Abstract
The use of intoxicants during pregnancy is recognized as being harmful to both the mother and the fetus.1 4 Detecting such use in order to intervene should be part of routine prenatal care. In the study by Chasnoff et al. in the April 26, 1990, issue,5 discrepancies related to race and economic status were identified in the reporting of substance and alcohol use. In another report,6 Chasnoff promotes a type of prenatal care in which basic clinical skills are used to evaluate lifestyle and to diagnose and intervene in substance abuse during pregnancy. To determine whether a model of biopsychosocially oriented prenatal care7 in an urban family-practice training site would adequately detect the use of alcohol and illicit substances in pregnancy, we compared the ability of routine clinical care to detect substance use with that of blinded, anonymous toxicologic testing of urine in the same patient population.