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In obstetrics, toxicology testing is often used to gather data about maternal substance use. A positive maternal or neonatal toxicology test can result in significant consequences, including referrals to child protective services, dismissal from substance use treatment programs, and possibly incarceration. The aim of this study was to evaluate the impact of administering neuraxial fentanyl during labor on toxicology test outcomes for mothers and neonates. This prospective cohort study involved pregnant individuals undergoing vaginal deliveries with neuraxial analgesia, excluding those with a history of substance use disorder (SUD), renal or hepatic dysfunction, or planned delivery without neuraxial analgesia. Urine samples were collected before neuraxial analgesia initiation as well as at various stages of labor and postpartum. Urine samples were also obtained from neonates before hospital discharge. Analysis …