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Cestonaro C, Terranova C, Carollo M, Russo A, Rosa-Rizzotto M, Viel G, Favretto D, Aprile A. Hair toxicological analysis of infants and their mothers: a 5-year retrospective study focusing on cocaine. Int J Legal Med 2024; 138:1307-1314. [PMID: 38400921 DOI: 10.1007/s00414-024-03180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
Prenatal and infant exposure to drugs of abuse is an emerging social and public health problem affecting children health and which may relate to child abuse and neglect. Exposure to drugs of abuse may occur through different routes, including intrauterine, breastfeeding, accidental intake, passive inhalation, and intentional administration. Currently, cases of suspected exposure can be investigated by hair toxicological analysis, the interpretation of which is, however, often difficult, leading to consequent difficulties in the management of such cases. In order to provide a contribution in terms of interpretation of the analytical results, this study aimed to search for the possible existence of elements, from a toxicological point of view, indicative towards the route of exposure. A retrospective study was performed on cases of suspected exposure to drugs of abuse in children aged 0-1 year, evaluated at a University Hospital between 2018 and 2022. Data of children hair toxicological analysis were analyzed and then compared with those of their mothers, when available; 41.6% children tested positive for cocaine. The study found a significant correlation between cocaine and benzoylecgonine concentrations, and a benzoylecgonine/cocaine ratio that tends to decrease as the age of children increases. From the comparison with mothers, a child/mother cocaine concentration ratio lower than 1 was found in all cases of hair sampled within the first week of life, and a ratio greater than or equal to 1 in all cases in which the sampling was performed later. These results, if confirmed in a larger cohort, could represent a contribution in the interpretation of cases of infant exposure to drugs of abuse and be integrated in the context of their multidisciplinary evaluation.
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Affiliation(s)
- Clara Cestonaro
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Massimo Carollo
- Clinical Pharmacology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessia Russo
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Melissa Rosa-Rizzotto
- Child Abuse and Neglect Crisis Unit, Paediatrics Department, Padua University Teaching Hospital, Padua, Italy
| | - Guido Viel
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Donata Favretto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna Aprile
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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2
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Kim SB, White B, Roberts J, Day CA. Substance use among pregnant women in NSW prisons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104256. [PMID: 37924608 DOI: 10.1016/j.drugpo.2023.104256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND AIMS Little is published about pregnant women in custody. Existing data on the prevalence of substance use among incarcerated pregnant women or their needs are scant. This study sought to determine the prevalence and characteristics of women with substance use histories who present to prison pregnant in New South Wales (NSW), Australia. DESIGN AND METHODS A retrospective review of prison medical health records was completed for pregnant women entering New South Wales custodial settings between January 2020 and June 2021. RESULTS We identified 158 prison receptions among 141 pregnant women (median age 28 years [IQR 25-33 years]), 42 % identified as Aboriginal or Torres Strait Islander. Eighty four percent of the women (n = 119) reported recent use of one or more than one substance and 36 % had injected drugs. The most commonly used substances were (meth)amphetamine (60 %), cannabis (40 %) and opioids (28 %). We found discrepancies between drug problems self-reported at reception screening on entry to prison and self-reported drug use collected during the subsequent drug and alcohol specialist assessment while incarcerated. Most (88 %) women described their current pregnancy as unplanned and half (52 %) were unaware they were pregnant before incarceration. CONCLUSIONS These findings highlight the high prevalence of substance use in incarcerated pregnant women and that many women are unaware of their pregnancy prior to incarceration. Findings emphasize the importance of timely and appropriate drug and alcohol assessment and treatment to minimize harm for both the mother and foetus and also underscore the urgent need for enhanced access to contraception for these women.
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Affiliation(s)
- So Bi Kim
- Drug and Alcohol Services, Justice Health Forensic Mental Health Network, Sydney, NSW, Australia; Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia.
| | - Bethany White
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia
| | - Jillian Roberts
- Drug & Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Carolyn A Day
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia
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3
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Noguez JH, Koch CD. Bridging the gap: The critical role of laboratory developed tests in clinical toxicology. J Mass Spectrom Adv Clin Lab 2023; 28:70-74. [PMID: 36872953 PMCID: PMC9982682 DOI: 10.1016/j.jmsacl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
•Toxicology testing provides valuable information for patient management.•Current in vitro diagnostics (IVDs) are unable to meet all clinical needs.•Lab-developed tests (LDTs) in toxicology can be used to close clinical care gaps.•LDTs in clinical toxicology are almost exclusively mass spectrometry-based methods.
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Affiliation(s)
- Jaime H Noguez
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA.,Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher D Koch
- Department of Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.,Sanford Laboratories, Sanford Health, Sioux Falls, SD, USA
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4
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Langman LJ, Rushton AM, Thomas D, Colbourne P, Seiden-Long I, Brun MM, Colantonio D, Jannetto PJ. Drug testing in support of the diagnosis of neonatal abstinence syndrome: The current situation. Clin Biochem 2023; 111:1-10. [PMID: 36379240 DOI: 10.1016/j.clinbiochem.2022.11.002] [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: 08/22/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Illicit drug use during pregnancy is a concern worldwide, with many international studies describing attempted strategies to mitigate this problem. Drug misuse during pregnancy is associated with significant maternal as well as perinatal complications, which include a high incidence of stillbirths, fetal distress, neonatal abstinence syndrome (NAS) and increased neonatal mortality. Unfortunately, the identification of a drug-exposed mother or neonate is challenging. Maternal disclosure of drug use is often inaccurate, principally due to psychosocial factors including behavioral denial or the fear of the consequences resulting from such admissions. Likewise, many infants who have been exposed to drugs in utero may appear normal at birth and initially show no overt manifestations of drug effects. Thus, the identification of the drug-exposed infant requires a high index of clinical suspicion. Conversely, analytical testing is an objective means of determining drug exposure when it may be necessary to document proof of the infant's exposure to illicit drugs. The review will discuss the different matrices that are most commonly used for testing (e.g., maternal urine, neonatal urine, meconium, and umbilical cord), the strengths and limitations for each matrix, which drugs and metabolites are appropriate for testing, the various testing methods, and the advantages and disadvantages of each method.
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Affiliation(s)
- Loralie J Langman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Alysha M Rushton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Dylan Thomas
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, Canada
| | - Penny Colbourne
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, Canada
| | - Isolde Seiden-Long
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Miranda M Brun
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, Canada
| | - David Colantonio
- Eastern Ontario Regional Laboratory Association and Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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5
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Midthun KM, Nelson BN, Strathmann FG, Browne T, Logan BK. Analysis of umbilical cord tissue as an indicator of in utero exposure to toxic adulterating substances. Front Pediatr 2023; 11:1127020. [PMID: 37025298 PMCID: PMC10070803 DOI: 10.3389/fped.2023.1127020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
In utero drug exposure is a significant public health threat to the well-being and normal development of the neonate. Recently, testing of umbilical cord tissue (UCT) has been employed to measure illicit drug exposure, as drugs used by the mother during the third trimester may be retained in the UCT. Focus has also been given to potential adverse health effects among drug users, resulting from exposure to pharmacologically active adulterants and cutting agents in the street drug supply. The in utero effects of these substances have not been well studied in humans, nor has their presence been demonstrated as a means for assessing adverse health effects in the neonate. Here, we describe the application of a novel test method to analyze UCT for the presence of more than 20 common adulterating/cutting substances via LC/Q-TOF. In total, 300 de-identified UCT samples were analyzed-all had previously tested positive for cocaine or opiates. Generally, the positivity rates of individual compounds were similar between the Cocaine and Opiates Subgroups, apart from levamisole, xylazine, dipyrone (metabolites), and promethazine. Many of the adulterants used in the street drug supply do have legitimate medicinal/therapeutic uses, including several of the compounds most frequently detected in this study. Caffeine and lidocaine were the most frequently identified compounds both individually (>70% each) and in combination with each other. Alternatively, levamisole, an adulterant with no legitimate therapeutic use, was present in 12% of cases. Importantly, this data demonstrates that the detection of traditional drugs of abuse may serve as indicators of potential in utero exposure to toxic adulterating substances during gestation. While there is cause for concern with respect to any unintentional drug exposure, illicit drug use during pregnancy, including uncontrolled dosing, poly-adulterant consumption, and the interactions of these drug mixtures, produces a significant public health threat to the neonate which warrants further study.
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Affiliation(s)
- Kari M. Midthun
- NMS Labs, Horsham, PA, United States
- Correspondence: Kari M. Midthun
| | | | | | - Thom Browne
- Colombo Plan Secretariat, Colombo, Sri Lanka
| | - Barry K. Logan
- NMS Labs, Horsham, PA, United States
- Center for Forensic Science Research and Education (CFSRE) at the Fredric Rieders Family Foundation, Willow Grove, PA, United States
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Rocha ADS, Falcão IR, Teixeira CSS, Alves FJO, Ferreira AJF, Silva NDJ, Almeida MFD, Ribeiro-Silva RDC. Determinants of preterm birth: proposal for a hierarchical theoretical model. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022278.03232022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Preterm birth (PB) is a syndrome resulting from a complex relationship between multiple factors which do not have fully understood relationships and causality. This article discusses a hierarchical theoretical model of PB determinants, considering maternal characteristics such as sociodemographic, psychosocial, nutritional, behavioral and biological aspects, traditionally associated with increased risk of PB. The variables were distributed in six dimensions within three hierarchical levels (distal, intermediate and proximal). In this model, the socioeconomic determinants of the mother, family, household and neighborhood play indirect effects on PB through variables at the intermediate level, which in turn affect biological risk factors at the proximal level that have a direct effect on PB. The study presents a hierarchical theoretical model of the factors involved in the PB determination chain and their interrelationships. Understanding these interrelationships is an important step in trying to break the causal chain that makes some women vulnerable to preterm birth.
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Affiliation(s)
| | - Ila Rocha Falcão
- Universidade Federal da Bahia, Brazil; Fundação Oswaldo Cruz, Brazil
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Rocha ADS, Falcão IR, Teixeira CSS, Alves FJO, Ferreira AJF, Silva NDJ, Almeida MFD, Ribeiro-Silva RDC. Determinants of preterm birth: proposal for a hierarchical theoretical model. CIENCIA & SAUDE COLETIVA 2022; 27:3139-3152. [PMID: 35894325 DOI: 10.1590/1413-81232022278.03232022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
Preterm birth (PB) is a syndrome resulting from a complex relationship between multiple factors which do not have fully understood relationships and causality. This article discusses a hierarchical theoretical model of PB determinants, considering maternal characteristics such as sociodemographic, psychosocial, nutritional, behavioral and biological aspects, traditionally associated with increased risk of PB. The variables were distributed in six dimensions within three hierarchical levels (distal, intermediate and proximal). In this model, the socioeconomic determinants of the mother, family, household and neighborhood play indirect effects on PB through variables at the intermediate level, which in turn affect biological risk factors at the proximal level that have a direct effect on PB. The study presents a hierarchical theoretical model of the factors involved in the PB determination chain and their interrelationships. Understanding these interrelationships is an important step in trying to break the causal chain that makes some women vulnerable to preterm birth.
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Affiliation(s)
- Aline Dos Santos Rocha
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
| | - Ila Rocha Falcão
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
| | - Camila Silveira Silva Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Flávia Jôse Oliveira Alves
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Andrêa Jacqueline Fortes Ferreira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Natanael de Jesus Silva
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Global de Barcelona, Hospital Clínic. Barcelona Espanha
| | | | - Rita de Cássia Ribeiro-Silva
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
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Schaeffer T, Canizares MF, Wall LB, Bohn D, Steinman S, Samora J, Manske MC, Hutchinson DT, Shah AS, Bauer AS. How Risky Are Risk Factors? An Analysis of Prenatal Risk Factors in Patients Participating in the Congenital Upper Limb Differences Registry. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:147-152. [PMID: 35601517 PMCID: PMC9120783 DOI: 10.1016/j.jhsg.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/02/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Risk factors for congenital upper limb differences (CoULDs) are often studied at the general population level. The CoULD registry provides a unique opportunity to study prenatal risk factors within a large patient sample. Methods All patients enrolled between June 2014 and March 2020 in the prospective CoULD registry, a national multicenter database of patients diagnosed with a CoULD, were included in the analysis. We analyzed self-reported, prenatal risk factors, including maternal smoking, alcohol use, recreational drug use, prescription drug use, gestational diabetes mellitus (GDM), and gestational hypertension. The outcome measures included comorbid medical conditions, proximal involvement of limb difference, bilateral involvement, and additional orthopedic conditions. Multivariable logistic regression was used to analyze the effect of the risk factors, controlling for sex and the presence of a named syndrome. Results In total, 2,410 patients were analyzed, of whom 72% (1,734) did not have a self-reported risk factor. Among the 29% (676) who did have at least 1 risk factor, prenatal maternal prescription drug use was the most frequent (376/2,410; 16%). Maternal prescription drug use was associated with increased odds of patient medical comorbidities (odds ratio [OR] = 1.43, P = .02). Gestational diabetes mellitus was associated with increased odds of comorbid medical conditions (OR = 1.58, P = .04), additional orthopedic conditions (OR = 1.51, P = .04), and proximal involvement (OR = 1.52, P = .04). Overall, reporting 1 or more risk factors increased the odds of patient comorbid medical conditions (OR = 1.42, P < .001) and additional orthopedic conditions (OR = 1.25, P = .03). Conclusions Most caregivers (72%) did not report a risk factor during enrollment. However, reporting a risk factor was associated with patient medical and orthopedic comorbidities. Of note, GDM alone significantly increased the odds of both these outcome measures along with proximal limb differences. These findings highlight the ill-defined etiology of CoULDs but suggest that prenatal risk factors, especially GDM, are associated with a higher degree of morbidity. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Tyler Schaeffer
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA
| | - Maria F. Canizares
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA
| | - Lindley B. Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
- Shriners Hospitals for Children – St. Louis, St. Louis, MO
| | - Deborah Bohn
- Gillette Children’s Specialty Healthcare, St. Paul, MN
| | | | | | | | | | | | - Andrea S. Bauer
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, MA
- Corresponding author: Andrea S. Bauer, MD, Boston Children’s Hospital, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115.
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Hunsaker JJH, La'ulu SL, LaGrave D, Murphy W, Reichman HA, Snow TM, McMillin GA, Johnson-Davis KL, Genzen JR. Tobacco and Cannabis Use During Pregnancy. Am J Clin Pathol 2022; 157:146-152. [PMID: 34508553 DOI: 10.1093/ajcp/aqab093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Nicotine (NIC) use during pregnancy can influence markers used in biochemical maternal serum screening. This study was designed to determine prevalence of disclosed tobacco smokers in our patient population and to compare disclosed tobacco smoking status with the presence of serum nicotine and a common tetrahydrocannabinol (THC) metabolite. METHODS A deidentified dataset of disclosed smoking status for quadruple (Quad) screens was obtained. Residual serum submitted for Quad screens was obtained from frozen storage and analyzed for NIC and THC metabolites. RESULTS Of specimens that had corresponding responses to the smoking history question on the patient history form, 7.2% (n = 1,783 of 24,611) specified that the patient was a tobacco smoker. Of the 271 specimens biochemically analyzed for NIC and THC metabolites, disclosed tobacco smokers had the highest prevalence of detectable NIC and THC metabolites. THC product use was most prevalent in patients categorized as probable tobacco smokers based on cotinine concentrations, as well as in younger patients. CONCLUSIONS Prevalence and concentration of NIC and THC metabolites vary based on disclosed tobacco smoker status. Biochemical testing may increase sensitivity for the identification of NIC and THC status over self-reporting.
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Affiliation(s)
- Joshua J H Hunsaker
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Sonia L La'ulu
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | | | | | | | - Taylor M Snow
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Gwendolyn A McMillin
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, UT, USA
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kamisha L Johnson-Davis
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, UT, USA
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jonathan R Genzen
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, UT, USA
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
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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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11
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Nelson BN, Strathmann FG, Browne T, Cervantes A, Logan BK. Qualitative LC/Q-TOF Analysis of Umbilical Cord Tissue via Data-Dependent Acquisition as an Indicator of In Utero Exposure to Toxic Adulterating Substances. J Anal Toxicol 2021; 46:619-624. [PMID: 34592760 DOI: 10.1093/jat/bkab094] [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: 02/19/2021] [Revised: 08/30/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Toxic adulterants are drug or chemical agents used to add bulk volume to traditional drugs of abuse such as cocaine, and heroin. These cutting agents include levamisole, metamizole, noxiptillin, phenacetin, and xylazine as well as common legal drugs such as acetaminophen, caffeine, diphenhydramine, lidocaine, quinine, quetiapine, and tramadol. Because they possess pharmacological activity they result in exposure of the user, but also in the case of pregnant women, the developing fetus, to potential drug toxicity. We describe the development, validation, and implementation of a rapid (48 second sample-to-sample) test based on a qualitative data-dependent liquid chromatography-quadrupole time of flight mass spectrometry (LC/Q-TOF) method for the analysis of toxic adulterating substances in umbilical cord tissue (UCT) samples. The method provides a means of studying potential in utero exposure to these agents. Library spectra comparison at 3 different collision energies was used in conjunction with retention time and accurate mass to identify these substances in UCT. Analytically based reporting limits were established to determine positivity rates of adulterants in UCT utilizing a standard addition approach. The method was applied to authentic cocaine and opioid positive UCT's to screen for toxic adulterants. There were a total of 82 potential adulterant positives found in a 30-sample cohort of authentic UCT samples, with an average of 2.7 substances per case. Lidocaine was the predominant finding followed by caffeine, and diphenhydramine all of which could result from non-illicit drug exposure, however, there were positives for levamisole, phenacetin, noxiptillin, and xylazine none of which are approved in the United States for human therapeutic use. This initial set of data established a preliminary positivity rate of potentially toxic adulterants in UCT samples positive for cocaine or opioid use.
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Affiliation(s)
| | | | - Thom Browne
- Colombo Plan Secretariat, 52, Ananda Coomaraswamy Mawatha, Colombo 3, P.O Box 596, Sri Lanka
| | | | - Barry K Logan
- NMS Labs, 200 Welsh Road, Horsham, PA 19044.,Center for Forensic Science Research and Education, 2300 Stratford Avenue, Willow Grove, PA 19090
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12
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Abdelrahman MS, Fouda MM, Ajarem JS, Maodaa SN, Allam AA, Khattab TA. Development of colorimetric cotton swab using molecular switching hydrazone probe in calcium alginate. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2020.128301] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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13
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Smith WT. Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment. J Subst Abuse Treat 2020; 116:108045. [DOI: 10.1016/j.jsat.2020.108045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022]
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Jensen TL, Wu F, McMillin GA. Detection of in utero Exposure to Cannabis in Paired Umbilical Cord Tissue and Meconium by Liquid Chromatography-Tandem Mass Spectrometry. CLINICAL MASS SPECTROMETRY 2019; 14 Pt B:115-123. [DOI: 10.1016/j.clinms.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 11/16/2022]
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15
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Hooks C. Attitudes toward substance misusing pregnant women following a specialist education programme: An exploratory case study. Midwifery 2019; 76:45-53. [DOI: 10.1016/j.midw.2019.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 04/02/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
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16
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Salt-Assisted Liquid-Liquid Extraction of Meconium for Analysis of Cocaine and Amphetamines by Liquid Chromatography-Tandem Mass Spectrometry. Methods Mol Biol 2019. [PMID: 30350292 DOI: 10.1007/978-1-4939-8823-5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Meconium, the first stool of a newborn, can be analyzed to identify prenatal exposure to drugs of abuse. Meconium accumulates in a fetus during the second and third trimesters of pregnancy providing a wide window of exposure. Identification of in utero drug exposure is essential for the diagnosis and treatment of infants for dependency/withdrawal caused from the exposure. However, testing of meconium samples is often cumbersome and time-consuming. Unlike liquid samples, meconium is a viscous, semisolid, tar-like substance that needs to be individually weighed prior to extraction. Additionally, the meconium matrix is not homogeneous and not easily mixed or extracted. A method for analyzing cocaine and metabolites as well as amphetamines in meconium utilizing ceramic homogenizers prior to salt-assisted liquid-liquid extraction and liquid chromatography tandem-mass spectrometry (LC-MS/MS) is presented.
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17
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Detection of In Utero Cannabis Exposure in Umbilical Cord Tissue by a Sensitive Liquid Chromatography-Tandem Mass Spectrometry Method. Methods Mol Biol 2019; 1872:211-222. [PMID: 30350293 DOI: 10.1007/978-1-4939-8823-5_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In utero exposure to cannabis may cause various short- and long-term health problems in newborns, such as low birth weight and neonatal withdrawal syndrome. Drug testing with umbilical cord tissue can be used to identify in utero exposure to cannabis. Here, we described a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method that simultaneously quantifies four cannabinoids in umbilical cord tissue, including tetrahydrocannabinol (THC), 11-nor-Δ9-carboxy-THC (THC-COOH), cannabinol (CBN), and 11-hydroxy-THC (11-OH-THC). Umbilical cord specimens are weighed and homogenized, and cannabinoids are extracted using anion exchange solid-phase extraction columns (AX-SPE). Liquid chromatography separation is performed, and quantitative results are obtained using LC-MS/MS.
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18
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Efficient determination of amphetamine and methylamphetamine in human urine using electro-enhanced single-drop microextraction with in-drop derivatization and gas chromatography. Anal Chim Acta 2019; 1045:162-168. [DOI: 10.1016/j.aca.2018.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 11/18/2022]
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19
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DeLisi M, Drury AJ, Elbert MJ. Parent Exposure to Drugs: A “New” Adverse Childhood Experience With Devastating Behavioral Consequences. JOURNAL OF DRUG ISSUES 2018. [DOI: 10.1177/0022042618805738] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Household drug abuse is one of the seminal forms of adverse childhood experiences, but it does not fully capture the severity of parents that actively provide or even administer drugs to their children. Drawing on a near population of federal supervised release offenders, the current study examined this “new” adverse childhood experience and its association with antisociality. Multiple analytical techniques (e.g., correlation, binary and multinomial logistic regression, and negative binomial regression) indicated that parent exposure to drugs was significantly associated with current drug status while on supervision, three forms of drug offending, and Cannabis, Cocaine, Methamphetamine, Opiate, and Alcohol Dependence even while controlling for age of arrest onset, sex, race, and current age. We concur with other scholars that more conceptualization and measurement-refinement of adverse childhood experiences is needed to fully understand how early-life trauma shapes the contours of the criminal career.
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Affiliation(s)
| | - Alan J. Drury
- United States Probation and Pretrial Services, Des Moines, USA
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20
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Wu F, Scroggin TL, Metz TD, McMillin GA. Development of a Liquid Chromatography-Tandem Mass Spectrometry Method for the Simultaneous Determination of Four Cannabinoids in Umbilical Cord Tissue. J Anal Toxicol 2018; 42:42-48. [PMID: 28977394 DOI: 10.1093/jat/bkx078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Indexed: 11/13/2022] Open
Abstract
In utero exposure to marijuana may cause various short- and long-term health problems, such as stillbirth, low birth weight and decreased cognitive function. Detection of in utero marijuana exposure with a relatively new specimen type, umbilical cord tissue, can be used to plan treatment and guide social management. In this study, a liquid chromatography-tandem mass spectrometry (LC-MS-MS) assay was developed for the simultaneous identification of four cannabinoids in umbilical cord tissue, including ∆9-tetrahydrocannabinol (THC), 11-nor-9-carboxy-∆9--THC (THC-COOH), 11-hydroxy-∆9-THC (11-OH-THC) and cannabinol (CBN). Within- and between-run imprecision, accuracy, linearity, sensitivity, carryover, recovery, matrix effects and specificity were evaluated using drug-free umbilical cord tissue spiked with non-deuterated and deuterated standards. Calibration curves were reproducible and linear (r > 0.995) for all four analytes in the range of 0.2 ng/g lower limit of quantitation (LLOQ) and 30 ng/g upper limit of quantitation (ULOQ). Total imprecisions (% coefficient of variation) were 7.8% (THC), 13.3% (THC-COOH), 11.8% (11-OH-THC) and 10.6% (CBN) at low QC (n = 15, 0.25 ng/g), and were 7.2% (THC), 10.0% (THC-COOH), 9.5% (11-OH-THC) and 5.8% (CBN) at high QC (n = 15, 4 ng/g), respectively. No interfering substances were identified, and no carryover was observed. The average accuracies (N = 25) were 94-95%. The average recoveries observed for THC, THC-COOH, 11-OH-THC and CBN were 74, 82, 58 and 86%, respectively. By analyzing authentic clinical specimens that had been previously tested for cannabinoids by enzyme-linked immunoassay, positive and negative result agreements were 100 and 53.8%. In summary, the presented method can be used for the assessment of in utero exposure to four common cannabinoids.
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Affiliation(s)
- Fang Wu
- Department of Pathology, University of Utah, 15 North Medical Drive East, Salt Lake City, UT 84132, USA
| | | | - Torri D Metz
- Denver Health and Hospital Authority, 777 Bannock Street, Denver, CO 80204, USA.,University of Colorado School of Medicine, Building 500-13001 E. 17th Place, Campus Box C290, Aurora, CO 80045, USA
| | - Gwendolyn A McMillin
- Department of Pathology, University of Utah, 15 North Medical Drive East, Salt Lake City, UT 84132, USA.,ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108, USA
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21
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Montanari E, Bonasoni MP, Licata M, Salomone A, Gerace E, Vivarelli M, Giorgetti R, Tagliabracci A. Toxicological and histological analyses for a stillborn delivered by a mother under methadone maintenance therapy. Forensic Toxicol 2018. [DOI: 10.1007/s11419-017-0402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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23
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Cook JL, Green CR, de la Ronde S, Dell CA, Graves L, Morgan L, Ordean A, Ruiter J, Steeves M, Wong S. Screening and Management of Substance Use in Pregnancy: A Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 39:897-905. [PMID: 28935055 DOI: 10.1016/j.jogc.2017.07.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 11/28/2022]
Abstract
Substance use during pregnancy has important implications for health care providers, policy makers, and can negatively impact a woman's health and the health of her children. Understanding trends, patterns of use and outcomes are critical to prevention campaigns, building awareness, and providing effective care. This review will discuss the current therapeutic approaches and recommendations for screening and patient management for substance use in pregnancy and during the postpartum period, and it is geared towards any care providers who care for patients or those who may care for patients who may be at risk for substance use during pregnancy.
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Affiliation(s)
- Jocelynn L Cook
- The Society for Obstetricians and Gynaecologists of Canada and the Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON.
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | | | | | - Lisa Graves
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI
| | | | - Alice Ordean
- Department of Family and Community Medicine, University of Toronto and St. Joseph's Health Centre, Toronto, ON
| | | | - Megan Steeves
- School of Public Health, University of Saskatchewan, Saskatoon, SK
| | - Suzanne Wong
- Department of Obstetrics and Gynecology and Department of Family and Community Medicine, University of Toronto, Toronto, ON
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24
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Paniagua-González L, Jiménez-Morigosa C, Lendoiro E, Concheiro M, Cruz A, López-Rivadulla M, de Castro A. Development and validation of a liquid chromatography-tandem mass spectrometry method for the determination of nicotine and its metabolites in placenta and umbilical cord. Drug Test Anal 2018; 10:1305-1314. [PMID: 29524345 DOI: 10.1002/dta.2381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/11/2022]
Abstract
Tobacco exposure during pregnancy is associated with obstetric and fetal complications. We developed and validated a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to determine nicotine, cotinine, and hydroxycotinine (OH-cotinine) in placenta (PL) and umbilical cord (UC). Specimens were homogenized in water, followed by solid-phase extraction. Chromatographic separation was performed using an Atlantis® HILIC Silica column. Detection was accomplished in electrospray in positive mode. Method validation included: linearity (5 to 1000 ng/g), accuracy (86.9 to 105.2% of target concentration in PL, and 89.1 to 105.0% in UC), imprecision (6.8 to 11.8% in PL, and 7.6 to 12.2% in UC), limits of detection (2 ng/g for cotinine and OH-cotinine, and 5 ng/g for nicotine) and quantification (5 ng/g), selectivity (no endogenous or exogenous interferences), matrix effect (-34.1 to -84.5% in PL, %CV = 9.1-24.0%; -18.9 to -84.7% in UC, %CV = 10.2-23.9%), extraction efficiency (60.7 to 131.5% in PL, and 64.1 to 134.2% in UC), and stability 72 h in the autosampler (<11.5% loss in PL, and < 13% loss in UC). The method was applied to 14 PL and UC specimens from tobacco users during pregnancy. Cotinine (6.8-312.2 ng/g in PL; 6.7-342.3 ng/g in UC) was the predominant analyte, followed by OH-cotinine (
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Affiliation(s)
- Lucía Paniagua-González
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristian Jiménez-Morigosa
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Elena Lendoiro
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
- School of Pharmacy and Life Sciences, The Robert Gordon University, Aberdeen, UK
| | - Marta Concheiro
- Department of Sciences, John Jay College of Criminal Justice, City University of New York, New York
| | - Angelines Cruz
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel López-Rivadulla
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana de Castro
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
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25
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Kotelchuck M, Cheng ER, Belanoff C, Cabral HJ, Babakhanlou-Chase H, Derrington TM, Diop H, Evans SR, Bernstein J. The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts. Matern Child Health J 2018; 21:893-902. [PMID: 27832443 DOI: 10.1007/s10995-016-2190-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives Despite widely-known negative effects of substance use disorders (SUD) on women, children, and society, knowledge about population-based prevalence and impact of SUD and SUD treatment during the perinatal period is limited. Methods Population-based data from 375,851 singleton deliveries in Massachusetts 2003-2007 were drawn from a maternal-infant longitudinally-linked statewide dataset of vital statistics, hospital discharges (including emergency department (ED) visits), and SUD treatment records. Maternal SUD and SUD treatment were identified from 1-year pre-conception through delivery. We determined (1) the prevalence of SUD and SUD treatment; (2) the association of SUD with women's perinatal health service utilization, obstetric experiences, and birth outcomes; and (3) the association of SUD treatment with birth outcomes, using both bivariate and adjusted analyses. Results 5.5% of Massachusetts's deliveries between 2003 and 2007 occurred in mothers with SUD, but only 66% of them received SUD treatment pre-delivery. Women with SUD were poorer, less educated and had more health problems; utilized less prenatal care but more antenatal ED visits and hospitalizations, and had worse obstetric and birth outcomes. In adjusted analyses, SUD was associated with higher risk of prematurity (AOR 1.35, 95% CI 1.28-1.41) and low birth weight (LBW) (AOR 1.73, 95% CI 1.64-1.82). Women receiving SUD treatment had lower odds of prematurity (AOR 0.61, 95% CI 0.55-0.68) and LBW (AOR 0.54, 95% CI 0.49-0.61). Conclusions for Practice SUD treatment may improve perinatal outcomes among pregnant women with SUD, but many who need treatment don't receive it. Longitudinally-linked existing public health and programmatic records provide opportunities for states to monitor SUD identification and treatment.
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Affiliation(s)
- Milton Kotelchuck
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children, Boston, MA, USA.
| | - Erika R Cheng
- Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Candice Belanoff
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | | | - Taletha M Derrington
- Center on Education and Human Services, Education Division, SRI International, Menlo ParkCA, USA
| | - Hafsatou Diop
- Office of Data Translation, Bureau of Family Health and Nutrition, Massachusetts Department of Public Health, Boston, MA, USA
| | - Stephen R Evans
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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26
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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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27
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Canfield M, Radcliffe P, Marlow S, Boreham M, Gilchrist G. Maternal substance use and child protection: a rapid evidence assessment of factors associated with loss of child care. CHILD ABUSE & NEGLECT 2017; 70:11-27. [PMID: 28551458 DOI: 10.1016/j.chiabu.2017.05.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 05/23/2023]
Abstract
This article reviews the literature on the factors associated with mothers who use substances losing care of their children. A rapid evidence assessment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Medline and PsycINFO databases were searched to identify primary research studies published in English during January 2000-September 2016. Studies were included if they presented individual, formal support (e.g., receiving substance use treatment) or informal support (e.g., receiving social and family support) factors associated with mothers who use substances retaining or losing care of their child/ren (losing care refers to child protection services placing child/ren under the custody of a family relative, foster care, child care institution, or adoption). Evaluation studies or trials of interventions were excluded as were studies that focused on reunification or re-entering care as the outcome. Thirteen studies were included. Factors associated with mothers who use substances losing care of their children included: maternal characteristics (low socioeconomic status, younger age of first child, criminal justice involvement); psychological factors (mental health co-morbidity, adverse childhood experiences); patterns of substance use (use of cocaine prenatally, injection drug use); formal and informal support (not receiving treatment for substance use, fewer prenatal care visits, lack of social support). There is not enough evidence to determine the influence of substance use treatment in preventing mothers losing care of their children. Factors identified in this review provide the evidence to inform a prevention agenda and afford services the opportunity to design interventions that meet the needs of those mothers who are more likely to lose care of their children.
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Affiliation(s)
- Martha Canfield
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Polly Radcliffe
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Sally Marlow
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Marggie Boreham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
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28
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Wang X, Zhu Y, Dave CV, Alrwisan AA, Voils SA, Winterstein AG. Trends of Neonatal Abstinence Syndrome Epidemic and Maternal Risk Factors in Florida. Pharmacotherapy 2017; 37:806-813. [PMID: 28500694 DOI: 10.1002/phar.1947] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to examine secular trends of (i) maternal prescription opioid use in late pregnancy, (ii) neonatal abstinence syndrome (NAS) stratified by late maternal prescription opioid use, and (iii) maternal risk factors among NAS deliveries. METHODS Women with a live birth who were enrolled 90 days before and 30 days after delivery in Florida Medicaid Analytic Extract billing records linked to birth certificates from 2000 to 2010 were identified for the study. Changes in the annual prevalence of prescription opioid use during pregnancy were tested with use of the Cochran-Armitage trend test. Temporal trends of NAS deliveries were estimated with the use of Poisson regression and stratified by prescription opioid exposure in the last 90 days of pregnancy in the study period. To identify contributors to the increase in NAS cases, variations in prevalence of opioid dispensing, tobacco use, antidepressant use, and substance use disorder among NAS and non-NAS deliveries were examined. RESULTS There were 41,968 (9.4%) deliveries exposed to at least one opioid prescription in late pregnancy, and this rate remained stable from 2000 to 2010. Among prescription opioid-exposed deliveries, frequency of NAS increased from 1.6 to 25.2 per 1000 live births during the study period (p<0.05). Although the prevalence of maternal use of prescription opioid, tobacco, and antidepressants remained stable among NAS deliveries from 2000 to 2010, the prevalence of substance use disorder diagnoses increased substantially from 38.9% in 2000 to 67.9% in 2006 (p<0.05). CONCLUSIONS The prevalence of NAS increased dramatically whereas the prevalence of major risk factors, including maternal prescription opioid use, remained stable in Florida between 2000 and 2010. The increase in substance use disorder may be responsible for the sharp increase in NAS deliveries.
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Affiliation(s)
- Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Yanmin Zhu
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Chintan V Dave
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Adel A Alrwisan
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida.,National Pharmacovigilance Center, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Stacy A Voils
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida.,Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
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29
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Development and validation of a liquid chromatography tandem mass spectrometry method for the determination of cannabinoids and phase I and II metabolites in meconium. J Chromatogr A 2017; 1497:118-126. [DOI: 10.1016/j.chroma.2017.03.066] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/24/2022]
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30
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Maghsoudlou S, Cnattingius S, Montgomery S, Aarabi M, Semnani S, Wikström AK, Bahmanyar S. Opium use during pregnancy and risk of preterm delivery: A population-based cohort study. PLoS One 2017; 12:e0176588. [PMID: 28448546 PMCID: PMC5407680 DOI: 10.1371/journal.pone.0176588] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/13/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Use of narcotic or "recreational" drugs has been associated with adverse pregnancy outcomes such as preterm delivery. However, the associations might be confounded by other factors related to high-risk behaviours. This is the first study to investigate the association between traditional opium use during pregnancy and risk of preterm delivery. METHOD AND FINDINGS We performed a population-based cohort study in the rural areas of the Golestan province, Iran between 2008 and 2010. We randomly selected 920 women who used (usually smoked) opium during pregnancy and 920 women who did not. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between the opium use during pregnancy and preterm delivery and adjustment was made for potential confounding factors. This study shows compared with non-use of opium and tobacco, use of only opium during pregnancy was associated with an increased risk of preterm delivery (OR = 1.56; 95% CI 1.05-2.32), and the risk was more than two-fold increased among dual users of opium and tobacco (OR = 2.31; 95% CI 1.37-3.90). We observed that opium use only was associated with a doubled risk for preterm caesarean delivery (OR = 2.05; 95% CI 1.10-3.82) but not for preterm vaginal delivery (OR = 1.25; 95% CI 0.75-2.07). Dual use of opium and tobacco was associated with a substantially increased risk of vaginal preterm delivery (OR = 2.58; 95% CI 1.41-4.71). CONCLUSIONS Opium use during pregnancy among non-tobacco smokers is associated with an increased risk of preterm caesarean delivery, indicating an increased risk of a compromised foetus before or during labour. Women who use both opium and smoked during pregnancy have an increased risk of preterm vaginal delivery, indicating an increased risk of spontaneous preterm delivery.
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Affiliation(s)
- Siavash Maghsoudlou
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden
| | - Sven Cnattingius
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden
| | - Scott Montgomery
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Mohsen Aarabi
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahriar Semnani
- Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Anna-Karin Wikström
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Shahram Bahmanyar
- Clinical Epidemiology Unit & Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute, Solna, Sweden
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Colby JM. Comparison of umbilical cord tissue and meconium for the confirmation of in utero drug exposure. Clin Biochem 2017; 50:784-790. [PMID: 28288850 DOI: 10.1016/j.clinbiochem.2017.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Drug screening in neonates is traditionally performed using meconium, but cord tissue has been proposed as an alternative specimen. This study compares the detection of drugs in a large number of paired meconium and umbilical cord tissue samples from subjects at risk of in utero drug exposure. DESIGN AND METHODS Physician-ordered toxicology results and clinical information were collected in a retrospective review of subject medical records. All toxicology testing was performed by a national reference laboratory using a combination of immunoassays and chromatography-mass spectrometry. The comparison was limited to drugs present in both cord and meconium panels. RESULTS Overall agreement between cord and meconium ranged from 76% (cannabinoids) to 100% (barbiturates), but Cohen's kappa was <65% for 5 of the 6 drug classes we studied. Considering meconium as the gold standard, cord was less sensitive for the detection of 5 of the 6 drug classes, and for the detection of all 5 individual opioids. For 3 of the 5 individual opioids, the concentration of drug measured in meconium did not correlate well with qualitative detection in cord. CONCLUSIONS This study reveals different sensitivities of drug detection in umbilical cord tissue and meconium. For the drugs studied here, meconium provides greater sensitivity, and is likely to remain the specimen of choice when sensitivity is of greatest importance. These results can help clinicians, laboratorians, and epidemiologists to (1) select the most appropriate test to confirm a suspected drug exposure and (2) interpret discordant results when testing is performed in multiple matrices.
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Affiliation(s)
- Jennifer M Colby
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4918B TVC, Nashville, TN 37232, USA.
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Roca Comas A, Vila Domènech JS, Massa Solé J, Timoneda Paz P, Peñas Boira M, Herrero Espinet FJ, Sánchez Jiménez J, Ballester Martínez A. Prevalence of illicit drug use at the end of pregnancy: a cross-sectional study at the time of birth. Minerva Pediatr 2017; 72:37-44. [PMID: 28176511 DOI: 10.23736/s0026-4946.17.04664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Drug use during pregnancy is associated with adverse perinatal outcomes. This study was conducted to assess the prevalence of consumption of drugs of abuse in pregnant women at the end of gestation. METHODS Cross-sectional study of all consecutive pregnant women in labor admitted to a regional hospital in Calella (Barcelona, Spain) in labor over one year (2014-2015). Women who gave written consent to take part in the study provided a urine sample on admission and completed a questionnaire with toxic-habit-related questions. RESULTS The study population included 862 women, 721 (83.6%) of which agreed to participate. Of the 721 urine samples obtained, 719 (99.7%) were valid for analysis. The prevalence of drugs of abuse was 5.4% (N.=39). Cannabis was the most frequently detected substance. No participant tested positive for opioids. In the multivariate analysis, predictors of illicit drug use were history of more than two abortions, premature delivery, self-reporting of consumption during pregnancy, poor obstetric control during gestation, and consideration of vulnerable pregnant woman. Based on the β coefficients of these five factors, a scoring system for discriminating positivity or negativity of drugs of abuse in urine testing was calculated (area under the ROC 0.84). CONCLUSIONS The prevalence of consumption of drugs of abuse at the end of pregnancy was 5.4%. A simple test based on five anamnestic variables is useful to discriminate women with positive and negative results of urine testing for drugs of abuse tested in this study.
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Affiliation(s)
- Amadeu Roca Comas
- Service of Pediatrics, Comarcal Sant Jaume de Calella Hospital, Corporació de Salut del Maresme i La Selva (Calella-Barcelona), Barcelona, Spain -
| | - Joan S Vila Domènech
- IMIM Research Institute, Hospital del Mar, Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Joana Massa Solé
- Service of Clinical Laboratory, Hospital Comarcal Sant Jaume de Calella, Corporació de Salut del Maresme i La Selva (Calella-Barcelona), Barcelona, Spain
| | - Patricia Timoneda Paz
- Service of Pediatrics, Comarcal Sant Jaume de Calella Hospital, Corporació de Salut del Maresme i La Selva (Calella-Barcelona), Barcelona, Spain
| | - Mar Peñas Boira
- Service of Pediatrics, Comarcal Sant Jaume de Calella Hospital, Corporació de Salut del Maresme i La Selva (Calella-Barcelona), Barcelona, Spain
| | - Francisco J Herrero Espinet
- Service of Pediatrics, Comarcal Sant Jaume de Calella Hospital, Corporació de Salut del Maresme i La Selva (Calella-Barcelona), Barcelona, Spain
| | - Josep Sánchez Jiménez
- Service of Pediatrics, Comarcal Sant Jaume de Calella Hospital, Corporació de Salut del Maresme i La Selva (Calella-Barcelona), Barcelona, Spain
| | - Anna Ballester Martínez
- Service of Pediatrics, Comarcal Sant Jaume de Calella Hospital, Corporació de Salut del Maresme i La Selva (Calella-Barcelona), Barcelona, Spain
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Epigenetic Influences During the Periconception Period and Assisted Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1014:15-39. [PMID: 28864983 DOI: 10.1007/978-3-319-62414-3_2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The periconception period starts 6 months before conception and lasts until the tenth week of gestation. In this chapter, we will focus on epigenetic modifications to DNA and gene expression within this period and during assisted reproduction. There are two critical times during the periconception window when significant epigenetic 'reprogramming' occur: one during gametogenesis and another during the pre-implantation embryonic stage. Furthermore, assisted conception treatments, laboratory protocols and culture media can affect the embryo development and birth weights in laboratory animals. There is, however, an ongoing debate as to whether epigenetic changes in humans, causing embryo mal-development, placenta dysfunction and birth defects, result from assisted reproductive technologies or are consequences of pre-existing medical and/or genetic conditions in the parents. The periconception period starts from ovarian folliculogenesis, through resumption of oogenesis, fertilisation, peri-implantation embryo development, embryogenesis until the end of organogenesis. In men, it is the period from spermatogenesis to epididymal sperm storage and fertilisation. Gametes and developing embryos are sensitive to environmental factors during this period, and epigenetic modifications can occur in response to adverse lifestyles and environmental factors. We now know that lifestyle factors such as advanced parentage age, obesity or undernutrition, smoking, excessive alcohol and caffeine intake and recreational drugs used during gamete production and embryogenesis could induce epigenetic alterations, which could impact adversely on pregnancy outcomes and health of the offspring. Furthermore, these can also result in a permanent and irreversible effect in a dose-dependent manner, which can be passed on to the future generations.
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Magri R, Hutson J, Míguez H, Suarez H, Menendez A, Parodi V, Koren G, Bustos R. Advances in the Determination of Alcohol and Other Drug Consumption during Pregnancy: A Study of 900 Births in Montevideo, Uruguay. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145090703400306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A study was performed in Uruguay to estimate the prevalence of drug consumption during pregnancy. The study consisted of a survey and biological samples to validate the responses and investigate information concerning risks involved in drug consumption during pregnancy. The survey consisted of 900 face-to-face interviews performed within 48 hours after birth. Perinatal registries were taken from hospital archives. Nine hundred meconium samples were tested for alcohol, tobacco, illegal drugs, and tranquilizers. The results of the survey indicated consumption during pregnancy of the following: 41.3% tobacco, 36.8% alcohol, 16.3% tranquilizers, 68% caffeine (more than 400 mg/day), and 1.4% illegal drugs. In addition, 8.9% of the pregnancies were unplanned. Among the planned pregnancies, some physicians warned their patients about risks associated with tobacco (34%), alcohol (27%) and illegal drugs (7%). Meconium analysis revealed tobacco (cotinine), 51.8%; alcohol (fatty acid ethyl esters, or FAEES), 43.5%; and cocaine (base paste), 2.5%. Newborns whose mothers smoked tobacco presented statistically lower birth weights: 11% of all newborns at low birth weight, with health problems reported for 14.8%.
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Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm. Matern Child Health J 2016; 19:2168-78. [PMID: 25680703 DOI: 10.1007/s10995-015-1730-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Substance use disorder (SUD) in women of reproductive age is associated with adverse health consequences for both women and their offspring. US states need a feasible population-based, case-identification tool to generate better approximations of SUD prevalence, treatment use, and treatment outcomes among women. This article presents the development of the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), a gender-tailored tool based upon existing International Classification of Diseases, 9th Edition, Clinical Modification diagnostic code-based groupers that can be applied to hospital administrative data. Gender-tailoring entailed the addition of codes related to infants, pregnancy, and prescription drug abuse, as well as the creation of inclusion/exclusion rules based on other conditions present in the diagnostic record. Among 1,728,027 women and associated infants who accessed hospital care from January 1, 2002 to December 31, 2008 in Massachusetts, EMSANT-W identified 103,059 women with probable SUD. EMSANT-W identified 4,116 women who were not identified by the widely used Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA) and did not capture 853 women identified by CCS-MHSA. Content and approach innovations in EMSANT-W address potential limitations of the Clinical Classifications Software, and create a methodologically sound, gender-tailored and feasible population-based tool for identifying women of reproductive age in need of further evaluation for SUD treatment. Rapid changes in health care service infrastructure, delivery systems and policies require tools such as the EMSANT-W that provide more precise identification methods for sub-populations and can serve as the foundation for analyses of treatment use and outcomes.
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Burrai L, Nieddu M, Carta A, Trignano C, Sanna R, Boatto G. Validated LC-MS-MS Method for Multiresidual Analysis of 13 Illicit Phenethylamines in Amniotic Fluid. J Anal Toxicol 2016; 40:194-200. [PMID: 26755540 DOI: 10.1093/jat/bkv143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A multi-residue analytical method was developed for the determination in amniotic fluid (AF) of 13 illicit phenethylamines, including 12 compounds never investigated in this matrix before. Samples were subject to solid-phase extraction using; hydrophilic-lipophilic balance cartridges which gave good recoveries and low matrix effects on analysis of the extracts. The quantification was performed by liquid chromatography electrospray tandem mass spectrometry. The water-acetonitrile mobile phase containing 0.1% formic acid, used with a C18 reversed phase column, provided adequate separation, resolution and signal-to-noise ratio for the analytes and the internal standard. The final optimized method was validated according to international guidelines. A monitoring campaign to assess fetal exposure to these 13 substances of abuse has been performed on AF test samples obtained from pregnant women. All mothers (n = 194) reported no use of drugs of abuse during pregnancy, and this was confirmed by the analytical data.
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Affiliation(s)
- Lucia Burrai
- Dipartimento di Chimica e Farmacia, Università di Sassari, Via Muroni 23/a, 07100 Sassari, Italy
| | - Maria Nieddu
- Dipartimento di Chimica e Farmacia, Università di Sassari, Via Muroni 23/a, 07100 Sassari, Italy
| | - Antonio Carta
- Dipartimento di Chimica e Farmacia, Università di Sassari, Via Muroni 23/a, 07100 Sassari, Italy
| | - Claudia Trignano
- Dipartimento di Scienze Biomediche, Università di Sassari, V.le San Pietro 43, 07100 Sassari, Italy
| | - Raimonda Sanna
- Dipartimento di Scienze Biomediche, Università di Sassari, V.le San Pietro 43, 07100 Sassari, Italy
| | - Gianpiero Boatto
- Dipartimento di Chimica e Farmacia, Università di Sassari, Via Muroni 23/a, 07100 Sassari, Italy
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Abstract
Consumption of drugs of abuse, tobacco and alcohol throughout pregnancy is a serious public health problem and results in an important economic cost to the health system. Drug and/or metabolites determination in biological matrices from mother and newborn is an objective measure of in utero drug exposure. We reviewed methods published for the determination of in utero drug exposure from 2007 to 2014, with special focus on meconium, placenta, umbilical cord and newborn hair. Accurate bioanalytical procedures are essential to obtain high-quality data to perform interventions and to establish correlations between analytical measures and clinical outcomes. We included a brief overview of clinical implications of in utero drug exposure to better understand the importance of this serious health issue.
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Hulvershorn LA, Schroeder KM, Wink LK, Erickson CA, McDougle CJ. Psychopharmacologic treatment of children prenatally exposed to drugs of abuse. Hum Psychopharmacol 2015; 30:164-72. [PMID: 25737371 DOI: 10.1002/hup.2467] [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: 06/26/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This pilot study compared the pharmacologic treatment history and clinical outcomes observed in pediatric outpatients with psychiatric disorders exposed to drugs of abuse in utero to those of an age-matched, sex-matched and psychiatric disorder-matched, non-drug-exposed group. METHODS In this matched cohort study, medical records of children treated at an academic, child and adolescent psychiatry outpatient clinic were reviewed. Children with caregiver-reported history of prenatal drug exposure were compared with a non-drug-exposed control group being cared for by the same providers. Patients were rated with the Clinical Global Impressions-Severity scale (CGI-S) throughout treatment. The changes in pre-treatment and post-treatment CGI-S scores and the total number of medication trials were determined between groups. RESULTS The drug-exposed group (n = 30) had a higher total number of lifetime medication trials compared with the non-drug-exposed group (n = 28) and were taking significantly more total medications, at their final assessment. Unlike the non-drug-exposed group, the drug-exposed group demonstrated a lack of clinical improvement. CONCLUSIONS These results suggest that in utero drug-exposed children may be more treatment-refractory to or experience greater side effects from the pharmacologic treatment of psychiatric disorders than controls, although we cannot determine if early environment or drugs exposure drives these findings.
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Affiliation(s)
- Leslie A Hulvershorn
- Section of Child and Adolescent Psychiatry, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Maternal and neonatal hair and breast milk in the assessment of perinatal exposure to drugs of abuse. Bioanalysis 2015; 7:1273-97. [DOI: 10.4155/bio.15.60] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Perinatal exposure to one or more drugs of abuse can affect the neonate temporarily or permanently. In addition to meconium, the evaluation of perinatal exposure to drugs of abuse has been achieved by testing biological matrices coming from the newborn (neonatal hair) and from the pregnant or nursing mother (maternal hair and breast milk). These matrices have the advantage of noninvasive collection and account for a sizable time window of active and passive exposure. Sensitive and specific analytical methods are required to determine minute amounts of drugs of abuse and metabolites in these matrices. The present manuscript reviews the newest analytical methods developed to detect drugs of abuse as well as ethanol biomarkers in maternal and neonatal hair and breast milk.
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Oghli AH, Alipour E, Asadzadeh M. Development of a novel voltammetric sensor for the determination of methamphetamine in biological samples on the pretreated pencil graphite electrode. RSC Adv 2015. [DOI: 10.1039/c4ra11399c] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We developed a simple and reliable sensor for the determination of methamphetamine without expensive and time-consuming pretreatments using PPGE.
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Affiliation(s)
| | - Esmaeel Alipour
- Electroanalytical Chemistry Lab
- Department of Analytical Chemistry
- Faculty of Chemistry
- University of Tabriz
- Tabriz
| | - Mojtaba Asadzadeh
- Electroanalytical Chemistry Lab
- Department of Analytical Chemistry
- Faculty of Chemistry
- University of Tabriz
- Tabriz
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David AL, Holloway A, Thomasson L, Syngelaki A, Nicolaides K, Patel RR, Sommerlad B, Wilson A, Martin W, Chitty LS. A case-control study of maternal periconceptual and pregnancy recreational drug use and fetal malformation using hair analysis. PLoS One 2014; 9:e111038. [PMID: 25360669 PMCID: PMC4215921 DOI: 10.1371/journal.pone.0111038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/26/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Maternal recreational drug use may be associated with the development of fetal malformations such as gastroschisis, brain and limb defects, the aetiology due to vascular disruption during organogenesis. Using forensic hair analysis we reported evidence of recreational drug use in 18% of women with a fetal gastroschisis. Here we investigate this association in a variety of fetal malformations using the same method. Methods In a multi-centre study, women with normal pregnancies (controls) and those with fetal abnormalities (cases) gave informed consent for hair analysis for recreational drug metabolites using mass spectrometry. Hair samples cut at the root were tested in sections corresponding to 3 month time periods (pre and periconceptual period). Results Women whose fetus had gastroschisis, compared to women with a normal control fetus, were younger (mean age 23.78±SD4.79 years, 18–37 vs 29.79±SD6 years, 18–42, p = 0.00001), were more likely to have evidence of recreational drug use (15, 25.4% vs 21, 13%, OR2.27, 95thCI 1.08–4.78, p = 0.028), and were less likely to report periconceptual folic acid use (31, 53.4% vs 124, 77.5%, OR0.33, 95thCI 0.18–0.63, p = 0.001). Age-matched normal control women were no less likely to test positive for recreational drugs than women whose fetus had gastroschisis. After accounting for all significant factors, only young maternal age remained significantly associated with gastroschisis. Women with a fetus affected by a non-neural tube central nervous system (CNS) anomaly were more likely to test positive for recreational drugs when compared to women whose fetus was normal (7, 35% vs 21, 13%, OR3.59, 95th CI1.20–10.02, p = 0.01). Conclusions We demonstrate a significant association between non neural tube CNS anomalies and recreational drug use in the periconceptual period, first or second trimesters, but we cannot confirm this association with gastroschisis. We confirm the association of gastroschisis with young maternal age.
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Affiliation(s)
- Anna L. David
- Institute for Women's Health, University College London, and University College London Hospitals NHS Foundation Trust, London, United Kingdom
- * E-mail:
| | - Andrew Holloway
- Institute for Women's Health, University College London, and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Louise Thomasson
- Institute for Women's Health, University College London, and University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Argyro Syngelaki
- Harris Birthright Centre, King's College Hospital, London, United Kingdom
| | - Kypros Nicolaides
- Harris Birthright Centre, King's College Hospital, London, and Institute for Women's Health, University College London, United Kingdom
| | - Roshni R. Patel
- Fetal Medicine Unit, St Michael's Hospital, Bristol, United Kingdom
| | - Brian Sommerlad
- North-Thames Cleft Lip and Palate Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Amie Wilson
- Birmingham Women's Hospital, Birmingham, United Kingdom
| | | | - Lyn S. Chitty
- Clinical and Molecular Genetics Unit, UCL Institute of Child Health, and University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. J Pregnancy 2014; 2014:906723. [PMID: 25254116 PMCID: PMC4164310 DOI: 10.1155/2014/906723] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/20/2014] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. METHODS We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. RESULTS Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166-$6,067), compared to $4,084 (95% CI: $4,002-$4,166) for nonusers. CONCLUSION Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs.
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Huestis MA, Smith ML. Modern analytical technologies for the detection of drug abuse and doping. DRUG DISCOVERY TODAY. TECHNOLOGIES 2014; 3:49-57. [PMID: 24980101 DOI: 10.1016/j.ddtec.2006.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Consequences to individuals convicted of abusing prohibited drugs or doping agents can be severe, including loss of employment, child custody, driving privileges, right to compete in international sports and ultimately freedom, when mandatory confinement occurs. In view of these penalties, laboratories charged with providing evidence must maximize testing accuracy. False positive and false negative tests are prevented by combining sensitive immunoassays and specific chromatographic-mass spectrometric detection. In addition, testing different biological matrices offers unique information about the drug-use history of an individual.:
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Affiliation(s)
- Marilyn A Huestis
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA.
| | - Michael L Smith
- Division of Forensic Toxicology, Office of the Armed Forces Medical Examiner, Rockville, MD 20850, USA
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Kalin JR. Incidence of fetal drug exposure in Alabama: 2004-2011. J Forensic Sci 2014; 59:1029-35. [PMID: 24528187 DOI: 10.1111/1556-4029.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 05/10/2013] [Accepted: 06/01/2013] [Indexed: 11/27/2022]
Abstract
Postmortem toxicological results for neonates and stillborn fetuses were examined to determine the incidence of drug exposure in utero and the relationship to fetal mortality. From 15,600 fatalities with toxicological analyses, 39 subjects were identified; 22 had positive findings (56%). Among the general population, 10,500 had positive findings (67%). Among the subject population, 22 drugs/metabolites were identified; cocaine/benzoylecgonine was most frequent (9 of 22 cases, 41%) then methamphetamine/amphetamine (7 of 22 cases, 32%). Respective incidences among the general positive population were 12% and 6%. Fetal/neonatal concentrations overlap the general population and exceed the mother. Remaining substances, detected largely in fatalities unrelated to drug exposure, were of little toxicological significance. The variety, with exceptions, reflects the general population. That the incidence of cocaine and methamphetamine among fetuses/neonates is three- and fivefold greater than the general population is evidence that maternal abuse of these drugs poses greater risk to fetal viability than all other substances identified.
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Affiliation(s)
- Jack R Kalin
- Alabama Department of Forensic Sciences, 2026 Valleydale Road, Hoover, AL, 35244
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Derakhshan R, Roodpeyma S, Balaee P, Bakhshi H. A Case-Control Study on Perinatal Outcomes of Opium-Addicted Pregnant Women and Their Offsprings in Rafsanjan, Iran. ACTA ACUST UNITED AC 2014. [DOI: 10.17795/compreped-14779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Płotka J, Narkowicz S, Polkowska Z, Biziuk M, Namieśnik J. Effects of addictive substances during pregnancy and infancy and their analysis in biological materials. REVIEWS OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2014; 227:55-77. [PMID: 24158579 DOI: 10.1007/978-3-319-01327-5_2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of addictive substances during pregnancy is a serious social problem, not only because of effects on the health of the woman and child, but also because drug or alcohol dependency detracts from child care and enhances the prospect of child neglect and family breakdown. Developing additive substance abuse treatment programs for pregnant women is socially important and can help ensure the health of babies, prevent subsequent developmental and behavioral problems (i.e., from intake of alcohol or other additive substances such as methamphetamine, cocaine,or heroine) and can reduce addiction costs to society. Because women of childbearing age often abuse controlled substances during their pregnancy, it is important to undertake biomonitoring of these substances in biological samples taken from the pregnant or nursing mother (e.g., blood, urine,hair, breast milk, sweat, oral fluids, etc.), from the fetus and newborn (e.g., meconium,cord blood, neonatal hair and urine) and from both the mother and fetus (i.e.,amniotic fluids and placenta). The choice of specimens to be analyzed is determined by many factors; however, the most important is knowledge of the chemical and physical characteristics of a substance and the route of it administration. Maternal and neonatal biological materials reflect exposures that occur over a specific time period, and each of these biological specimens has different advantages and disadvantages,in terms of accuracy, time window of exposure and cost/benefit ratio.Sampling the placenta may be the most important biomonitoring choice for assessing in utero exposure to addictive substances. The use of the placenta in scientific research causes a minimum of ethical problems, partly because its sampling is noninvasive, causes no harm to mother or child, and partly because, in any case,placentas are discarded and incinerated after birth. Such samples, when properly analyzed, may provide key essential information about fetal exposure to toxic substances, and may provide the groundwork for protecting the fetus or newborn and the mother from further damage.Several sensitive and specific bioanalytical methods are commonly utilized to accurately measure for drug biomarkers of in utero drug exposure. Moreover, several immunoassay methods are used to rapidly screen for drugs in many biological specimen types. However, results from immunoassays should be carefully interpreted,and should be confirmed by more specific and sensitive chromatographic methods, such as GC-MS or LC-MS. Although techniques for analysis of addictive substances are still being developed or are being refined, current methods are efficient and sensitive and provide valuable information on human exposures to addictive substances and their metabolites.
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Affiliation(s)
- Justyna Płotka
- Department of Analytical Chemistry, Chemical Faculty, Gdansk University of Technology (GUT), 11/12 Narutowicza Street, 80-233, Gdańsk, Poland,
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47
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Narkowicz S, Płotka J, Polkowska Ż, Biziuk M, Namieśnik J. Prenatal exposure to substance of abuse: a worldwide problem. ENVIRONMENT INTERNATIONAL 2013; 54:141-163. [PMID: 23454110 DOI: 10.1016/j.envint.2013.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/15/2013] [Accepted: 01/20/2013] [Indexed: 06/01/2023]
Abstract
Substance abuse during pregnancy is an important public health issue affecting the mother and the growing infant. Preterm labor, miscarriage, abruption and postpartum hemorrhage are obstetric complications which have been associated with women who are dependent on abused substances. Moreover, women are also at an increased risk of medical problems such as poor nutrition, anemia, urinary tract infections as well as sexually transmitted infections, hepatitis, HIV and problems related to infection. Intrauterine growth restriction, prematurity, stillbirth, neonatal abstinence syndrome, and Sudden Infant Death Syndrome represent only some of fetal effects. Later on, during childhood, it has been shown that in utero exposure to substances of abuse is associated with increased rates of respiratory infections, asthma, ear and sinus infections. Moreover, these children are more irritable, have difficulty focusing their attention, and have more behavioral problems. Therefore, the assessment of in utero exposure to abused substance is extremely necessary and is relevant for the care of the mother and the offspring. In this sense, several approaches are possible; however, recently the evaluation of in utero exposure to abused drugs has been achieved by testing biological specimens coming from fetus or newborn, pregnant or nursing mother, or from both the fetus and the mother. Maternal and neonatal biological materials reflect exposure in a specific time period and each of them has different advantages and disadvantages in terms of accuracy, time window of exposure and cost/benefit ratio. The methodology for identification and determination of abused substances in biological materials are of great importance. Consequently, sensitive and specific bioanalytical methods are necessary to accurately measure biomarkers. Different immunoassays methods are used as screening methods for drug testing in the above reported specimens, however, the results from immunoassays should be carefully interpreted and confirmed by a more specific and sensitive chromatographic methods such as GC-MS or LC-MS. The interest in the development and optimization of analytical techniques to detect abused substances in different specimens is explained by the several possibilities and information that they can provide.
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Affiliation(s)
- Sylwia Narkowicz
- Department of Analytical Chemistry, Chemical Faculty, Gdansk University of Technology (GUT) 11/12 Narutowicza Street, 80-233 Gdańsk, Poland.
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48
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49
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Chuang E, Wells R, Bellettiere J, Cross TP. Identifying the substance abuse treatment needs of caregivers involved with child welfare. J Subst Abuse Treat 2013; 45:118-25. [PMID: 23453481 DOI: 10.1016/j.jsat.2013.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/13/2012] [Accepted: 01/22/2013] [Indexed: 11/26/2022]
Abstract
Parental substance use significantly increases risk of child maltreatment, but is often under-identified by child protective services. This study examined how agency use of standardized substance use assessments and child welfare investigative caseworker education, experience, and caseload affected caseworkers' identification of parental substance abuse treatment needs. Data are from a national probability sample of permanent, primary caregivers involved with child protective services whose children initially remained at home and whose confidential responses on two validated instruments indicated harmful substance use or dependence. Investigative caseworkers reported use of a formal assessment in over two thirds of cases in which substance use was accurately identified. However, weighted logistic regression indicated that agency provision of standardized assessment instruments was not associated with caseworker identification of caregiver needs. Caseworkers were also less likely to identify substance abuse when their caseloads were high and when caregivers were fathers. Implications for agency practice are discussed.
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Affiliation(s)
- Emmeline Chuang
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr. San Diego, CA 92182-4162, USA.
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50
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Simultaneous determination of opiates, methadone, amphetamines, cocaine, and metabolites in human placenta and umbilical cord by LC-MS/MS. Anal Bioanal Chem 2013; 405:4295-305. [DOI: 10.1007/s00216-013-6784-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 12/19/2012] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
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