自我报告与尿液毒理学在孕早期非法使用苯丙胺和可卡因的一致性。
Agreement Between Self-reports and Urine Toxicology Measures of Illicit Methamphetamine and Cocaine Use During Early Pregnancy.
机构信息
From the Division of Research, Kaiser Permanente Northern California, Oakland, CA (ACS, SEA, NES, LAA, SRA, AP, KCY-W); Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (ACS); Regional Offices, Kaiser Permanente Northern California, Oakland, CA (NG, AC, DA); Herbert Wertheim College of Medicine, Florida International University, Miami, FL (AP); Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI (RLG, LM); Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI (RLG, LM); and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA (KCY-W).
出版信息
J Addict Med. 2024;18(1):28-32. doi: 10.1097/ADM.0000000000001230. Epub 2023 Oct 5.
OBJECTIVE
This study aimed to assess agreement between self-report and urine toxicology measures assessing use of 2 illicit simulants (methamphetamine and cocaine) during early pregnancy.
METHODS
This cross-sectional study of 203,053 pregnancies from 169,709 individuals receiving prenatal care at Kaiser Permanente Northern California between January 1, 2011, and December 31, 2019, assessed agreement ( κ , sensitivity, and specificity) between self-reported frequency and urine toxicology measures of methamphetamine and cocaine early in pregnancy.
RESULTS
Prenatal use of the illicit stimulants was rare according to toxicology (n = 244 [0.12%]) and self-report measures (n = 294 [0.14%]). Agreement between these measures was low ( κ < 0.20). Of the 498 positive pregnancies, 40 (8.03%) screened positive on both measures, 204 (40.96%) screened positive on toxicology tests only, and 254 (51.00%) screened positive by self-report only. Relative to toxicology tests, sensitivity of any self-reported use was poor with 16.39% (95% confidence interval [CI], 11.75%-21.04%) of pregnancies with a positive toxicology test self-reporting any use in pregnancy. Relative to self-report, sensitivity of toxicology tests was also poor with 13.61% (95% CI, 9.69%-17.52%) of pregnancies who self-reported any use having positive urine toxicology tests. The sensitivity improved slightly at higher frequencies of self-reported use: daily, 17.50% (95% CI, 5.72%-29.29%); weekly, 25.00% (95% CI, 11.58%-38.42%); and monthly or less, 11.06% (95% CI, 6.89%-15.23%). Specificity was high (>99%), reflecting the high negative rate of use.
CONCLUSIONS
Findings suggest that using self-report and toxicology measures in combination likely provides the most accurate information on methamphetamine and cocaine use in early pregnancy. Findings also highlight the need to provide supportive nonstigmatizing environments in which pregnant individuals feel comfortable disclosing substance use without fear of punishment.
目的
本研究旨在评估自我报告与尿液毒理学检测在评估早孕期间使用 2 种非法模拟药物（冰毒和可卡因）方面的一致性。
方法
这项横断面研究纳入了 2011 年 1 月 1 日至 2019 年 12 月 31 日期间在 Kaiser Permanente 北加利福尼亚接受产前护理的 169709 名个体的 203053 例妊娠，评估了自我报告的频率与妊娠早期尿液毒理学检测之间在评估冰毒和可卡因使用方面的一致性（κ、敏感度和特异性）。
结果
根据毒理学检测（n=244[0.12%]）和自我报告（n=294[0.14%]），妊娠期间使用这些非法兴奋剂的情况罕见。这些检测之间的一致性较低（κ<0.20）。在 498 例阳性妊娠中，40 例（8.03%）在两种检测中均呈阳性，204 例（40.96%）仅在毒理学检测中呈阳性，254 例（51.00%）仅在自我报告中呈阳性。与毒理学检测相比，任何自我报告使用的敏感度均较差，16.39%（95%置信区间[CI]，11.75%-21.04%）的阳性毒理学检测妊娠报告了妊娠期间有任何使用情况。与自我报告相比，毒理学检测的敏感度也较差，13.61%（95%CI，9.69%-17.52%）的自我报告有任何使用情况的妊娠尿液毒理学检测呈阳性。当自我报告的使用频率较高时，敏感度略有提高：每日，17.50%（95%CI，5.72%-29.29%）；每周，25.00%（95%CI，11.58%-38.42%）；每月或更少，11.06%（95%CI，6.89%-15.23%）。特异性较高（>99%），反映了使用率的高阴性率。
结论
研究结果表明，将自我报告和毒理学检测相结合可能提供关于早孕期间冰毒和可卡因使用最准确的信息。研究结果还强调，需要提供支持性的非污名化环境，使孕妇感到舒适，愿意披露物质使用情况，而不必担心受到惩罚。
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