The challenges of screening for substance use in pregnant women: Commentary on the 4P'S Plus tool

Abstract

Chasnoff and colleagues tested the ability of a five-item brief screening instrument, 4P's Plus© to detect substance use in pregnant women receiving prenatal care. The patient population was diverse in both geographical location and socioeconomic status. Results showed that 21.9% of patients admitted tobacco use and 20% reported alcohol use in the month prior to pregnancy awareness. It was interesting to note that approximately 50% of the women who used alcohol in the month before pregnancy awareness spontaneously quit. Of women continuing to consume alcohol, the majority drank less than 2 days a week. The rate of use of cocaine, heroin and methamphetamines was 1% after pregnancy awareness. In contrast to the spontaneous quit rates observed with alcohol and illicit drug use, almost all women continued smoking through the rest of pregnancy. The strengths of this study that merit comment are numerous; however, three are discussed. Three areas of critique are also presented.