Abstract
Screening for substance use disorder (SUD) is an essential part of antepartum care. Best practice for screening requires the use of a validated tool early in pregnancy to identify those at risk and to connect them with counseling and treatment. In many health systems and practices, urine toxicology testing is erroneously employed as a SUD screening tool despite consistent recommendations against its routine use. The results are often misinterpreted as diagnostic of SUD and can have harmful downstream effects for pregnant and birthing people. This Clinical Rounds reviews the tools available for evidence-based SUD screenings in pregnancy care, pitfalls of urine toxicology testing, and ways in which midwifery care is well-positioned to implement evidence-based screening practices in pregnancy care.