Variation in Prenatal and Newborn Toxicology Testing Policies in Michigan Hospitals

Objectives: This study examines hospital policies on prenatal and newborn toxicology testing, and subsequent referral to child protective services (CPS) for suspected abuse and neglect in Michigan. We assessed variability between hospitals, alignment with state law, and consistency with professional guidelines. Methods: This cross-sectional survey was conducted between February 1, 2024, and September 1, 2024. All 76 birth hospitals in Michigan were invited to participate. The 10-question survey addressed hospital protocols for prenatal and newborn toxicology testing, indications for testing in risk-based protocols, informed consent policies, protocols for reporting to child protective services, and specific policies for cannabis exposure and patients receiving medication treatment for opioid use disorder. Results: Of 76 birth hospitals in Michigan, 25 completed the survey (response rate 33%). Hospitals reported variability in prenatal and newborn toxicology testing policies. Of respondents, 28% (7/25) reported universal prenatal toxicology testing and 68% (17/25) reported risk-based testing. Most hospitals (23/25) used a risk-based testing strategy for newborns. The most common risk-based indication was no prenatal care (12/17). Although guidelines recommend informed consent for all prenatal toxicology tests, only 56% (14/25) of hospitals required informed consent for prenatal toxicology testing and only 20% (5/25), required informed consent from a parent for newborn toxicology testing. Conclusions: Variability in hospital prenatal and newborn toxicology testing policies, even within a single state’s regulatory framework, highlights opportunities for quality improvement at the level of hospital policy to improve the ethical treatment of birth parents and newborns with potential exposures to substance use during pregnancy.