Opinion | Urine toxicology screen took joy of childbirth due to poppy seed bagel


Jack and Katie Keenan considered the birth of their first child to be the most joyous moment of their lives. They knew they wanted a child when they got married and felt lucky to be pregnant within a year of their marriage.The pregnancy went smoothly and her waters broke 10 days before her due date. did.

Shortly before giving birth to a healthy baby girl, Makenzie, Katie underwent a series of tests at the Greater Baltimore Medical Center. One of them was a urinalysis and made a startling discovery. was positive for opioids.

The results are alarming because babies born to mothers using opioids can develop neonatal withdrawal syndrome (NAS). withdrawal symptoms. This includes feeding difficulties, vomiting, fever and seizures. An untreated NAS is lethal.

However, Katie has strongly denied using opioids. She did not take painkillers or use illegal substances.

When questioned, she reported eating two “everything” bagels containing poppy seeds. They are not opioids and do not cause NAS, but they can mimic morphine and codeine and cause positive urine tests.

Maryland, like most states, requires reporting of a positive drug test, so a social worker initiated an investigation and told Child Protective Services that it might be involved. rice field. Katie was very keen to breastfeed Mackenzie, but a lactation consultant told her she was not allowed to help.

Initially, Jack and Katie were told the family could go home in two days. Mackenzie then said she would have to stay for up to five days for observations and tests, and that if the hospital was overbooked, Katie might have to leave while she had her baby. I found out

“It was traumatic for us,” Jack told me. “The worst moment is when you realize you can’t go home with your baby even if you want to.”

Keenans’ story is not unique. Other women in Maryland, New York, and Kentucky who ate poppy seed-containing foods claimed they were humiliated and denied bonding time with their infants. A newborn baby was taken away for 2 months after eating a salad containing berries.

Stephen W. Patrick, director of the Vanderbilt Center for Child Health Policy and the recent senior adviser to the White House Office of National Drug Control Policy, called urinalysis “problematic.” Not only can certain foods and medicines cause false positives, requiring reporting and investigation, but the test’s usefulness is limited because it only measures material intake at a specific moment in time.

If your goal is to diagnose drug use and treat your mother and reduce your baby’s risk, what you need is a conversation with a trusted provider and a quick connection to addiction treatment.

“Child welfare agencies rely heavily on maternal toxicology testing, but using toxicology screening alone is not recommended by the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists,” Patrick told me. Testing can compromise the clinician-patient relationship, especially if done without the mother’s permission or knowledge.

Still, given how serious NAS can get, is it that bad when some women are flagged as inaccurate and their babies are kept for observation?

Lauren Jansson, a pediatrician at Johns Hopkins University who specializes in caring for babies born to women addicted to opioids, acknowledges the shortcomings of urine testing, but a universal test could lead to more potential NAS cases. stated that it may be possible to discover Furthermore, testing only women deemed at high risk may be discriminatory. Group opioid use may be overlooked.

Because some NAS babies may not show symptoms for several days, her hospital must observe babies exposed to opioids during pregnancy for four days to monitor withdrawal. “Without diagnosis and treatment, withdrawal can be fatal,” she said.

The hospital where Mackenzie was born believes that the ultimate goal is to protect newborns and that universal testing will improve the health of babies. My sympathies go out to Keenans and other families who owe this. And how many families would endure unnecessary scrutiny? Is that proportion acceptable?

I don’t know, but I think the policy on mandatory urine drug screening should be re-evaluated. Most states, including Maryland, don’t require these tests, but many hospitals have them in their delivery protocols. inspection is included.

At the very least, a concerted effort is needed to mitigate the risk of unnecessary investigations. Pregnant women approaching their due date should be warned about substances that can cause false positives, such as poppy seeds. You should also explicitly agree after explaining what will happen if you get a positive result.

No family should turn the joy of a child’s birth into a trauma. The medical system must prevent other families from suffering like the Keenan family.

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