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Towobola A, Towobola B, Nair B, Makwana A. The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review. BJPsych Bull 2023; 47:28-37. [PMID: 34749839 PMCID: PMC10028554 DOI: 10.1192/bjb.2021.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006-2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. RESULTS Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. CLINICAL IMPLICATIONS This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.
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Affiliation(s)
| | | | - Bosky Nair
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| | - Arti Makwana
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
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2
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Jones J. Toxicology as a diagnostic tool to identify the misuse of drugs in the perinatal period. Front Pediatr 2022; 10:1071564. [PMID: 36843886 PMCID: PMC9944414 DOI: 10.3389/fped.2022.1071564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/23/2022] [Indexed: 02/11/2023] Open
Abstract
The use, misuse, and abuse of substances are a continued public health concern in this country and around the world. Perinatal exposure to substances of abuse is associated with several long-term negative consequences for the neonate. Limited resources exist to assist perinatal health professionals on this very complex subject. The purpose of this document is to provide additional information about selecting monitoring protocols, the specifics of appropriate testing methodologies, and the interpretation of toxicological findings. Understanding these concepts better allows perinatal healthcare professionals to be a voice for the voiceless in order to protect and enrich lives during this unprecedented opioid epidemic.
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Affiliation(s)
- Joseph Jones
- United States Drug Testing Laboratories, Des Plaines, IL, United States
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Roca A, Jarque P, Gomila I, Marchei E, Tittarelli R, Elorza MÁ, Sanchís P, Barceló B. Clinical features and risk factors associated with prenatal exposure to drugs of abuse. An Pediatr (Barc) 2021; 95:307-320. [PMID: 34635463 DOI: 10.1016/j.anpede.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Early identification of neonates exposed to drugs of abuse during pregnancy allows a more precise clinical management. OBJECTIVES To describe the clinical characteristics and to identify risk factors associated with the early detection of neonates exposed to drugs of abuse in a Neonatal Intermediate and Intensive Care Unit. METHODS Prospective observational study of neonates with and without clinical suspicion of prenatal exposure to drugs of abuse. Meconium was analyzed using standard chromatographic techniques. Univariate and multivariate statistical analyzes were performed. RESULTS 372 neonates were included. Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one. Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol. In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one. The most clinically relevant independent risk factors useful to detect cases of prenatal exposure to drugs of abuse were (Odds ratio (95% CI)): reason for admission other than prematurity (5.52 (2.55-1.93)), length percentile less than 33 (1.95 (1.05-3.60) and 2.14 (1.04-3.40) in older than 34 PW) and social dystocia/uncontrolled pregnancy in older than 34 PW (4.47 (1.03-19.29)). CONCLUSIONS There are somatometric alterations and risk factors that can help in the early detection of neonates exposed to drugs of abuse. The somatometric alterations identified can be useful to extend the differential diagnosis of these alterations and to study their causes.
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Affiliation(s)
- Antonia Roca
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pilar Jarque
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Isabel Gomila
- Servicio de Análisis Clínicos, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Emilia Marchei
- Centro Nacional de Adicciones y Dopaje, Instituto Superior de Salud, Roma, Italy
| | - Roberta Tittarelli
- Unidad de Toxicología Forense, Departamento de Ciencias Anatómicas, Histológicas, Forenses y Ortopédicas, Universidad de Sapienza, Roma, Italy
| | - Miguel Ángel Elorza
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Pilar Sanchís
- Departamento de Química, Universidad de las Islas Baleares, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Bernardino Barceló
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.
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Jarque P, Roca A, Gomila I, Marchei E, Tittarelli R, Elorza MÁ, Sanchís P, Barceló B. Role of Neonatal Biomarkers of Exposure to Psychoactive Substances to Identify Maternal Socio-Demographic Determinants. BIOLOGY 2021; 10:biology10040296. [PMID: 33916618 PMCID: PMC8067052 DOI: 10.3390/biology10040296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary The rapid identification of newborns exposure to psychoactive drugs allows an appropriate clinical care. This study tried to identify maternal profiles that help to identify newborns exposed to psychoactive drugs during pregnancy. Mothers were interviewed using a questionnaire. The biomarkers of fetal exposure were measured in meconium samples. Statistical analysis was performed to identify the maternal characteristics that were most likely to be associated with drug use during pregnancy. Of a total of 372 mothers, 49 (13.2%) tested positive for psychoactive drugs use: 24 (49.0%) for cannabis, 11 (22.5%) for ethyl glucuronide, six (12.2%) for cocaine, and eight (16.3%) for more than one psychoactive substance. The maternal characteristics that most likely identify substance use during pregnancy are: maternal age < 24 years, lack of pregnancy care, single-mother families, and active tobacco smoking. The profiles of prenatal maternal exposure identified in a clinical setting can be used to request specific detection tests for identifying newborns exposed to these drugs. Abstract Background: The accurate assessment of fetal exposure to psychoactive substances provides the basis for appropriate clinical care of neonates. The objective of this study was to identify maternal socio-demographic profiles and risk factors for prenatal exposure to drugs of abuse by measuring biomarkers in neonatal matrices. Methods: A prospective, observational cohort study was completed. Biomarkers of fetal exposure were measured in meconium samples. The mothers were interviewed using a questionnaire. Univariate and multivariate logistic regression analyses were performed. Results: A total of 372 mothers were included, 49 (13.2%) testing positive for psychoactive substances use: 24 (49.0%) for cannabis, 11 (22.5%) for ethyl glucuronide, six (12.2%) for cocaine, and in eight (16.3%) more than one psychoactive substance. Mothers who consumed any psychoactive substance (29.7 ± 6.6 years) or cannabis (27.0 ± 5.7 years) were younger than non-users (32.8 ± 6.2 years, p < 0.05). Cocaine (50.0% vs. 96.9%, p < 0.05) and polydrug users (37.5% vs. 96.9%, p < 0.05) showed a lower levels of pregnancy care. Previous abortions were associated with the use of two or more psychoactive substances (87.5% vs. 37.8%, p < 0.05). Single-mother families (14.3% vs. 2.5%, p < 0.05) and mothers with primary level education (75.5% vs. 55.1%, p < 0.05) presented a higher consumption of psychoactive substances. Independent risk factors that are associated with prenatal exposure include: maternal age < 24 years (odds ratio: 2.56; 95% CI: 1.12–5.87), lack of pregnancy care (odds ratio: 7.27; 95%CI: 2.51–21.02), single-mother families (odds ratio: 4.98; 95%CI: 1.37–8.13), and active tobacco smoking (odds ratio: 8.13; 95%CI: 4.03–16.43). Conclusions: These results will allow us to develop several risk-based drug screening approaches to improve the early detection of exposed neonates.
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Affiliation(s)
- Pilar Jarque
- Department of Pediatrics, Division of Neonatology, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain; (P.J.); (A.R.)
- Pediatric Multidisciplinary Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Antonia Roca
- Department of Pediatrics, Division of Neonatology, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain; (P.J.); (A.R.)
- Pediatric Multidisciplinary Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Isabel Gomila
- Clinical Analysis Service, Son Llàtzer University Hospital, Manacor Road, 07198 Palma de Mallorca, Spain;
- Clinical Toxicology Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain;
| | - Emilia Marchei
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy;
| | - Roberta Tittarelli
- Department of Anatomical, Unit of Forensic Toxicology, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy;
| | - Miguel Ángel Elorza
- Clinical Toxicology Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain;
- Clinical Analysis Service, Clinical Toxicology Unit, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Pilar Sanchís
- Department of Chemistry, University of the Balearic Islands, Valldemossa Road, km 7.5, 07122 Palma de Mallorca, Spain;
- Research Group in Vascular and Metabolic Pathologies, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Bernardino Barceló
- Clinical Toxicology Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain;
- Clinical Analysis Service, Clinical Toxicology Unit, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
- Correspondence: ; Tel.: +34-871205000 (ext. 65476)
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Roca A, Jarque P, Gomila I, Marchei E, Tittarelli R, Elorza MÁ, Sanchís P, Barceló B. [Clinical features and risk factors associated with prenatal exposure to drugs of abuse]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30285-X. [PMID: 33041240 DOI: 10.1016/j.anpedi.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Early identification of neonates exposed to drugs of abuse during pregnancy allows a more precise clinical management. OBJECTIVES To describe the clinical characteristics and to identify risk factors associated with the early detection of neonates exposed to drugs of abuse in a Neonatal Intermediate and Intensive Care Unit. METHODS Prospective observational study of neonates with and without clinical suspicion of prenatal exposure to drugs of abuse. Meconium was analyzed using standard chromatographic techniques. Univariate and multivariate statistical analyzes were performed. RESULTS 372 neonates were included. Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one. Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol. In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one. The most clinically relevant independent risk factors useful to detect cases of prenatal exposure to drugs of abuse were (Odds ratio (95% CI)): reason for admission other than prematurity (5.52 (2.55-1.93)), length percentile less than 33 (1.95 (1.05-3.60) and 2.14 (1.04-3.40) in older than 34 PW) and social dystocia/uncontrolled pregnancy in older than 34 PW (4.47 (1.03-19.29)). CONCLUSIONS There are somatometric alterations and risk factors that can help in the early detection of neonates exposed to drugs of abuse. The somatometric alterations identified can be useful to extend the differential diagnosis of these alterations and to study their causes.
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Affiliation(s)
- Antonia Roca
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Pilar Jarque
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Isabel Gomila
- Servicio de Análisis Clínicos, Hospital Universitario Son Llàtzer, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España
| | - Emilia Marchei
- Centro Nacional de Adicciones y Dopaje, Instituto Superior de Salud, Roma, Italia
| | - Roberta Tittarelli
- Unidad de Toxicología Forense, Departamento de Ciencias Anatómicas, Histológicas, Forenses y Ortopédicas, Universidad de Sapienza, Roma, Italia
| | - Miguel Ángel Elorza
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España
| | - Pilar Sanchís
- Departamento de Química, Universidad de las Islas Baleares, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España
| | - Bernardino Barceló
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España.
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Roncero C, Valriberas-Herrero I, Mezzatesta-Gava M, Villegas JL, Aguilar L, Grau-López L. Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders. A systematic review. Reprod Health 2020; 17:25. [PMID: 32066469 PMCID: PMC7027300 DOI: 10.1186/s12978-020-0880-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This study analyze factors associated to cannabis use in pregnant women, its perceived availability, its risk perception and the relationship between prenatal exposure to cannabis and developmental and mental disorders. OBJECTIVES We present a review of the literature on cannabis use among pregnant women. The objective is to analyze factors associated to cannabis use during pregnancy and assess the potential effects of prenatal exposure to cannabis on the development of the fetus and the mental health of those exposed. METHODS Systematic review of studies on the maternal use of cannabis and the relationship between early exposure and the development of psychiatric disorders in the PubMed database until July 2018 in English and Spanish with the following keywords: Marijuana, Cannabinoids, Mental disorders, Pregnancy, Prenatal Cannabis Exposure, Risk factors. RESULTS The use of cannabis among pregnant women is frequent but it has not been extensively researched. Prenatal exposure to cannabis may be associated with affective symptoms and ADHD. CONCLUSIONS Mental healthcare professionals who treat women during their fertile life need to be able to explain the relationship between prenatal exposure to cannabis and the presence of developmental and mental disorders.
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Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain. .,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.
| | - Isabel Valriberas-Herrero
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Marcela Mezzatesta-Gava
- Multidisciplinary Unit of Autism Spectrum Disorder (UnimTEA), Mental Health Department, Sant Joan de Deu Hospital, Barcelona, Spain
| | - José L Villegas
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Lourdes Aguilar
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Psychiatric Service, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomus University of Barcelona, Barcelona, Spain
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Cook JL, Blake JM. Cannabis: Implications for Pregnancy, Fetal Development, and Longer-Term Health Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:1204-1207. [PMID: 30268315 DOI: 10.1016/j.jogc.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON.
| | - Jennifer M Blake
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
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Chiandetti A, Hernandez G, Mercadal-Hally M, Alvarez A, Andreu-Fernandez V, Navarro-Tapia E, Bastons-Compta A, Garcia-Algar O. Prevalence of prenatal exposure to substances of abuse: questionnaire versus biomarkers. Reprod Health 2017; 14:137. [PMID: 29070078 PMCID: PMC5657059 DOI: 10.1186/s12978-017-0385-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/12/2017] [Indexed: 01/18/2023] Open
Abstract
Alcohol and drugs of abuse consumption in young adults, including women of childbearing age, has experienced significant increase over the past two decades. The use of questionnaires as the only measure to investigate prenatal alcohol and drugs of abuse exposure underestimates the real prevalence of exposure and could mislead to wrong conclusions. Therefore, the aim of this article was to compare reported rates of prenatal alcohol and drugs of abuse consumption with biomarkers of exposure by a comprehensive review of the available literature. We searched MEDLINE and EMBASE databases for articles catalogued between 1992 and 2015. We identified relevant published studies that assessed the comparison between prenatal exposure to alcohol and drugs of abuse assessed by self-reported questionnaire of consumption versus biomarkers of exposure. Thirteen studies were included regarding alcohol consumption, and seven of them about drugs of abuse. Women who admitted consumption during pregnancy by questionnaire varied from 0 to 37% for alcohol, from 0 to 4.3% for cocaine, and 2.9% for tetrahydrocannabinol (THC). Positive biomarkers results ranged from 16 to 44% for alcohol, 15.4% for cocaine, and from 4 to 12.4% for THC. Biomarkers should always complement questionnaires, as it has been shown that self-report may underestimate prenatal exposure to substances of abuse.
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Affiliation(s)
- Antonella Chiandetti
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gimena Hernandez
- Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Grup de Recerca en Farmacologia (GRF), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María Mercadal-Hally
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Airam Alvarez
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Vicente Andreu-Fernandez
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Elisabet Navarro-Tapia
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Adriana Bastons-Compta
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Oscar Garcia-Algar
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain. .,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Lamy S, Hennart B, Houivet E, Dulaurent S, Delavenne H, Benichou J, Allorge D, Marret S, Thibaut F. Assessment of tobacco, alcohol and cannabinoid metabolites in 645 meconium samples of newborns compared to maternal self-reports. J Psychiatr Res 2017; 90:86-93. [PMID: 28237885 DOI: 10.1016/j.jpsychires.2017.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/28/2023]
Abstract
Prenatal psychoactive substance exposure has significant impact on neonatal health and child development and the development of reliable biomarkers is critical. Meconium presents several advantages for detecting prenatal exposure to psychoactive substances, as it is easy to collect and provides a broad time frame of exposure (third trimester). The aim of our study was to compare the prevalence of alcohol, tobacco and/or cannabis use during the third trimester of pregnancy (using maternal self-reports) with the results of meconium testing of their metabolites in newborns (cotinine, ethyl-glucuronide (EtG) and cannabinoid metabolites). Among all deliveries (993) that occurred in all maternities in Rouen (Normandy) during a defined time period (5 consecutive weeks in August, 2010 and August, 2011), 724 mothers were included and 645 meconium samples were collected. Maternal self-reports, using the Addiction Severity Index (5th edition), and meconium samples were collected within 72 h of delivery. Cotinine detection appears highly correlated to maternal self-reports (Kappa value: 0.79; [95%CI: 0.73-0.85]). Moreover, detection in meconium seems more accurate in the prediction of neonatal consequences of prenatal tobacco exposure as compared to maternal self-reports. In contrast, we have found a lower concordance between maternal self-reports and meconium testing for EtG and cannabinoid metabolites (Kappa value: 0.13; [95%CI: 0.04-0.22] and: 0.30; [95%CI: -0.03-0.63], respectively); however the total number of EtG- and cannabinoid-positive meconium samples was small. Interestingly, meconium samples with the highest levels of EtG mainly corresponded to negative maternal self-reports. Fetal exposure to alcohol, tobacco or cannabis may also considerably differ as displayed in our pairs of dizygotic twins. Finally, a polyconsumption of these psychoactive substances was not frequently observed according to meconium testing. In conclusion, cotinine detection appears as a valuable meconium biomarker. EtG measurement in meconium samples seems interesting if there is any risk of high fetal exposure, whereas assessment of prenatal cannabis exposure, using meconium testing, needs to be improved.
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Affiliation(s)
- Sandrine Lamy
- Department of Addictology, Ramsay- General de Santé, SSR Petit Colmoulins, Harfleur, France; University Hospital Cochin (site Tarnier), University Sorbonne Paris-Cité (Paris V), Faculty of Medicine Paris Descartes, INSERM U894, Centre Psychiatry and Neurosciences, Paris, France.
| | - Benjamin Hennart
- CHU Lille, Service de Toxicologie-Génopathies, F-59000 Lille, France.
| | - Estelle Houivet
- Department of Biostatistics, University Hospital Rouen, Centre d'Investigation Clinique et de Ressources Biologiques, INSERM CIC-CRB, 1404 Rouen, France.
| | - Sylvain Dulaurent
- Laboratoire de Pharmacologie, Toxicologie et Pharmacovigilance, Hôpital Dupuytren, CHU de Limoges, France.
| | - Heloise Delavenne
- Department of Psychiatry, Faculty of Medicine, Federal University of Minas Gerais, Brazil.
| | - Jacques Benichou
- Department of Biostatistics, University Hospital Rouen, Centre d'Investigation Clinique et de Ressources Biologiques, INSERM CIC-CRB, 1404 Rouen, France.
| | - Delphine Allorge
- CHU Lille, Service de Toxicologie-Génopathies, F-59000 Lille, France; Univ.Lille, EA 4483-IMPECS- IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France.
| | - Stéphane Marret
- Department of Neonatal Medicine-Neuropediatrics, Rouen University Hospital and INSERM U 1245, Neovasc Team, Perinatal neurological handicap and Neuroprotection, Institute of Biomedical Research and Innovation, School of Medicine, Normandy University, France.
| | - Florence Thibaut
- University Hospital Cochin (site Tarnier), University Sorbonne Paris-Cité (Paris V), Faculty of Medicine Paris Descartes, INSERM U894, Centre Psychiatry and Neurosciences, Paris, France.
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10
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García-Algar O, Mur Sierra A. [Exposure to drugs of abuse in paediatrics]. An Pediatr (Barc) 2013; 79:65-7. [PMID: 23809727 DOI: 10.1016/j.anpedi.2013.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022] Open
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