CLN Daily
Perinatal drug screening combines a form of testing that many providers struggle to interpret with one of the most biologically complex patient presentations. When you pepper in the legal, ethical, and analytical ramifications of the results, you get a recipe for some difficult conversations.
While current clinical guidelines recommend universal perinatal drug screening to reduce bias, important questions remain. For example, how can laboratorians help ensure that clinicians are appropriately screening and obtaining consent before specimens are collected?
In the Thursday scientific session at ADLM 2026, “Advancing equity in maternal drug testing: From ethical challenges to informatics solutions,” presenters will explore how institutions are using laboratory and informatics systems to deal with these thorny issues. The session will highlight institutional perspectives, clinical concerns that shaped their approaches, and the practical solutions they developed and implemented.
Ideally, clinical testing should serve as a pathway to care, including timely linkage to substance-use treatment when appropriate. In many jurisdictions, a positive urine drug screen during pregnancy can carry legal, professional, and personal consequences that extend beyond clinical care. In some states, civil statutes require healthcare personnel to report suspected prenatal substance use, and a small number also mandate testing under certain circumstances.
In this session, Lauren Nacke, MSW, LCSW, a social worker and doctoral candidate in public health in St. Louis, Missouri, will share how urine drug testing was tailored at her institution to address the ethical consequences of substance-use reporting. Her perspective raises an important question: Is a comprehensive panel always the best answer?
Although fetal alcohol syndrome has been connected to social intervention and the social determinants of health for nearly 50 years, it is rarely assessed in clinical maternal and perinatal drug testing. Joyce Liao, PhD, DABCC, of the University of Washington in Seattle, will examine the clinical rationale for testing various measurands and the interpretive challenges that alcohol analytes and other results can present. Her presentation will be a good refresher on common interfering substances and cross-reactivities, and this unique clinical context will serve as a lens for understanding the analytical issues that laboratories encounter every day.
Because no examination of perinatal toxicology would be complete without THC, the session will also include extensive discussion about the appropriateness of including this substance as a measurand in perinatal urine panels. As the legality of cannabis varies across the country—from illegal in some jurisdictions to permitted for medical or recreational purposes in others—healthcare decisions about THC testing in each of these settings require careful consideration of clinical purpose, consent, local policy, and potential downstream consequences. Presenters will discuss how their institutions have approached these questions in practice.
Many of the solutions that will be covered in this session were implemented using informatic technologies that are already available in many healthcare systems. The speakers will describe how these tools were used to close clinical gaps, support decision-making, and improve testing workflows, while also identifying areas where gaps remain. Attendees may leave with new ideas for using existing tools at their own institution.
This session is designed to help laboratory professionals begin meaningful conversations with clinical care teams at their institutions. Session moderator Vahid Azimi, MD, hopes the presenters’ perspectives will show how “clinical culture, state statutes, informatics tools, and clinical practice have combined to develop a solution that meets the need of each institution.”
In this specialized testing space, there is no single right answer. Instead, the presentations will offer practical strategies for evaluating current practice, identifying gaps, and advancing solutions that may reduce racial inequities in this sensitive and complex area of testing.