Maternal and Child Health Journal

, Volume 23, Issue 2, pp 250–257 | Cite as

Prenatal Substance Use and Perceptions of Parent and Partner Use Using the 4P’s Plus Screener

  • Emmanuel. A. OgaEmail author
  • Erica. N. Peters
  • Katrina Mark
  • Kathleen Trocin
  • Victoria. H. Coleman-Cowger


Background Prenatal substance use screening is recommended. The 4 P’s Plus screener includes questions on perceived problematic substance use in parents and partner that are not considered in risk stratification. Objectives This research examined the: (1) prevalence of self-reported problematic parental and partner substance use and associations with biochemically-verified prenatal substance use; (2) utility of self-reported perceptions of parent/partner substance use as proxies for prenatal substance use; and (3) degree to which the sensitivity of the 4P’s Plus can be augmented with consideration of parent/partner questions in risk stratification. Methods A convenience sample of 500 pregnant women was recruited between January 2017 and January 2018. Participants completed the 4P’s Plus and provided urine for drug testing. Diagnostic utility of problematic parent/partner substance use questions was assessed, then compared to the 4P’s Plus used as designed, and to the 4P’s Plus used with these 2 questions included in risk stratification. Results Half (51%) of respondents reported either partner or parental problematic substance use. When partner or parent problematic substance use were considered as proxies for prenatal substance use, sensitivity was 65% and specificity was 55%. When used as intended, sensitivity was 94% and specificity was 29%. Including partner/parent questions increased sensitivity to 96% but lowered specificity (19%). Partner substance use and combined partner/parent use were associated with prenatal substance use [adjusted odds ratio (aOR): 2.0 (1.2, 2.4; p = 0.006); aOR = 1.6 (1.1, 2.5, p = 0.04)]. Conclusions for Practice Sensitivity of the 4P’s Plus may improve with inclusion of self-reported problematic partner/parent substance use items in risk stratification.


4P’s Plus Drug use Pregnancy Partner Parent Sensitivity Prenatal 



We would like to recognize and appreciate the contributions of Sage Roth, Bartosz Koszowski, Geraldine Baltazar, Elaine Madison and Linda McLellan to the execution of this study.

Author Contributions

EAO and VCC conceived the study. EAO, ENP, VCC, KT and KM conducted literature searches and provided summaries of previous research studies. EAO conducted the statistical analysis. EAO, ENP, KT, KM and VCC participated in the writing of the first draft of the manuscript and all authors contributed to and have approved the final manuscript.


Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA041328. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Research Triangle InstituteRockvilleUSA
  2. 2.Battelle Memorial InstituteBaltimoreUSA
  3. 3.University of Maryland School of MedicineBaltimoreUSA
  4. 4.CommunicateHealthRockvilleUSA
  5. 5.The Emmes CorporationRockvilleUSA

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