Oga Emmanuel A, Peters Erica N, Mark Katrina, Trocin Kathleen, Coleman-Cowger Victoria H
Research Triangle Institute, 6110 Executive Boulevard, Suite 900, Rockville, MD, 20852, USA.
Battelle Memorial Institute, Baltimore, MD, USA.
Matern Child Health J. 2019 Feb;23(2):250-257. doi: 10.1007/s10995-018-2647-2.
Background Prenatal substance use screening is recommended. The 4 P's Plus screener includes questions on perceived problematic substance use in parents and partner that are not considered in risk stratification. Objectives This research examined the: (1) prevalence of self-reported problematic parental and partner substance use and associations with biochemically-verified prenatal substance use; (2) utility of self-reported perceptions of parent/partner substance use as proxies for prenatal substance use; and (3) degree to which the sensitivity of the 4P's Plus can be augmented with consideration of parent/partner questions in risk stratification. Methods A convenience sample of 500 pregnant women was recruited between January 2017 and January 2018. Participants completed the 4P's Plus and provided urine for drug testing. Diagnostic utility of problematic parent/partner substance use questions was assessed, then compared to the 4P's Plus used as designed, and to the 4P's Plus used with these 2 questions included in risk stratification. Results Half (51%) of respondents reported either partner or parental problematic substance use. When partner or parent problematic substance use were considered as proxies for prenatal substance use, sensitivity was 65% and specificity was 55%. When used as intended, sensitivity was 94% and specificity was 29%. Including partner/parent questions increased sensitivity to 96% but lowered specificity (19%). Partner substance use and combined partner/parent use were associated with prenatal substance use [adjusted odds ratio (aOR): 2.0 (1.2, 2.4; p = 0.006); aOR = 1.6 (1.1, 2.5, p = 0.04)]. Conclusions for Practice Sensitivity of the 4P's Plus may improve with inclusion of self-reported problematic partner/parent substance use items in risk stratification.
建议进行产前物质使用筛查。4P's Plus筛查工具包含了关于父母及伴侣中存在问题的物质使用的问题，而这些问题在风险分层中未被考虑。目的：本研究考察了：（1）自我报告的父母及伴侣存在问题的物质使用的患病率及其与经生化验证的产前物质使用的关联；（2）自我报告的对父母/伴侣物质使用的认知作为产前物质使用替代指标的效用；（3）在风险分层中考虑父母/伴侣问题后，4P's Plus的敏感性能够提高的程度。方法：在2017年1月至2018年1月期间招募了500名孕妇的便利样本。参与者完成了4P's Plus并提供尿液进行药物检测。评估了存在问题的父母/伴侣物质使用问题的诊断效用，然后将其与按设计使用的4P's Plus以及在风险分层中纳入这两个问题后的4P's Plus进行比较。结果：一半（51%）的受访者报告伴侣或父母存在问题的物质使用。当将伴侣或父母存在问题的物质使用视为产前物质使用的替代指标时，敏感性为65%，特异性为55%。按预期使用时，敏感性为94%，特异性为29%。纳入伴侣/父母问题后，敏感性提高到96%，但特异性降低（19%）。伴侣物质使用以及伴侣/父母联合使用与产前物质使用相关[调整后的优势比（aOR）：2.0（1.2，2.4；p = 0.006）；aOR = 1.6（1.1，2.5，p = 0.04）]。实践结论：在风险分层中纳入自我报告的存在问题的伴侣/父母物质使用项目可能会提高4P's Plus的敏感性。
