Racial disparities in drug toxicology testing among pregnant women & infants: a meta-analysis and systematic review

Introduction: We synthesized evidence on racial disparities in perinatal toxicology testing among Black and White women and their infants in the United States, including testing practices and downstream consequences such as child welfare involvement. Methods: We systematically searched PubMed and PsycINFO for peer-reviewed studies published before January 2023 that examined perinatal toxicology testing and reported racial outcomes. Eligible studies assessed testing practices or related consequences. A random-effects meta-analysis estimated pooled rate ratios (RRs) and 95% confidence intervals (CIs) for disparities in testing. Thematic synthesis summarized qualitative findings on downstream outcomes. Sixteen studies (1993-2023) met inclusion criteria; six contributed to the meta-analysis, encompassing over 50 000 pregnant women and/or their infants. Results: Black women and their infants were significantly more likely to be tested than their White counterparts (RR = 2.58; 95% CI: 2.03-3.29). While recent studies suggest disparities in referral to child welfare services after positive tests may be narrowing, earlier research indicates disproportionate reporting and child removal among Black and Hispanic families. Conclusion: Racial inequities in perinatal and infant toxicology testing persist, with implications for maternal and child health. Future research should investigate multilevel drivers of these disparities and inform equitable policy and practice.