Neonatal Abstinence Syndrome

Priority 4: Policies & Procedures

NAS Policies And ProceduresScreening questions about prenatal exposure to alcohol and other substances, as well as disclosure of that information, is often hampered by fear of punitive sanctions. Research suggests that women of color have a greater likelihood of screening for drug use during pregnancy, so it’s important that protocols to engage women are non-punitive and free of barriers to treatment including stigma, fear of losing child custody and worries about being away from family during inpatient or residential treatment.

According to the American Academy of Pediatrics, such punitive measures toward pregnant women with SUD are ineffective, and women who experience them are less likely to seek treatment and more likely to avoid prenatal care. Instead, research supports a comprehensive evidence-based, non-punitive approach to coordinated health, including primary prevention, universal screening aligned with ACOG recommendations, access to comprehensive prenatal care and providers trained in policies and requirements.

What’s missing is the evidence that provides guidance for the prevention and management of substance use disorders during pregnancy. While providing an individual baseline that includes information about unhealthy drug use, screening is most effective when there are services in place to accept referrals to care. Models should include a framework for continued engagement with women between pregnancies to provide opportunities to address complications and medical issues that impact long-term health.


  • Engage health system, hospital, community and family stakeholders who meet the unique diverse needs of the populations served by hospital providers.
  • Evaluate the complement of stakeholders involved in the process to ensure effective engagement.
  • Consider and engage referral sources for inpatient and outpatient care.
  • Establish baseline measurements that include:
    1. Pregnant women universally screened for substance misuse by physicians at the hospital
    2. Which criteria pregnant women are screened and tested for at the hospital for substance misuse
    3. The percentage of pregnant women who receive prenatal care at hospital-operated clinics who are screened prior to entering labor and delivery.
  • Identify strengths and weaknesses of the evidence supporting clinical action steps to be considered when caring for women and their infants.
  • Apply a universal screening approach to identify women at risk for substance use disorder that includes: understanding the nature of the patient’s substance use, underlying or co-occurring diseases or conditions, effect of opioid use on the patient’s physical and psychological functioning and outcomes of past treatment episodes.
  • Establish a standard for when (during the pregnancy) and where (location of care) screening will occur.
  • Build clinician consensus on the use of validated tools for screening and assessment.
  • Apply a universal referral and transfer protocol for women and infants at risk.
  • Develop orientation and education protocols for all pharmacological staff who interact with mothers and babies, as appropriate.

For more information on NJHA’s activities to improve maternal and child health,