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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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Joseph Davey DL, Pintye J, Baeten JM, Aldrovandi G, Baggaley R, Bekker L, Celum C, Chi BH, Coates TJ, Haberer JE, Heffron R, Kinuthia J, Matthews LT, McIntyre J, Moodley D, Mofenson LM, Mugo N, Myer L, Mujugira A, Shoptaw S, Stranix‐Chibanda L, John‐Stewart G. Emerging evidence from a systematic review of safety of pre-exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading? J Int AIDS Soc 2020; 23:e25426. [PMID: 31912985 PMCID: PMC6948023 DOI: 10.1002/jia2.25426] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/20/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION HIV incidence is high during pregnancy and breastfeeding with HIV acquisition risk more than doubling during pregnancy and the postpartum period compared to when women are not pregnant. The World Health Organization recommends offering pre-exposure prophylaxis (PrEP) to pregnant and postpartum women at substantial risk of HIV infection. However, maternal PrEP national guidelines differ and most countries with high maternal HIV incidence are not offering PrEP. We conducted a systematic review of recent research on PrEP safety in pregnancy to inform national policy and rollout. METHODS We used a standard Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach to conduct a systematic review by searching for completed, ongoing, or planned PrEP in pregnancy projects or studies from clinicaltrials.gov, PubMed and NIH RePORTER from 2014 to March 2019. We performed a systematic review of studies that assess tenofovir disoproxil fumarate (TDF)-based oral PrEP safety in pregnant and breastfeeding HIV-uninfected women. RESULTS AND DISCUSSION We identified 14 completed (n = 5) and ongoing/planned (n = 9) studies that evaluate maternal and/or infant outcomes following PrEP exposure during pregnancy or breastfeeding. None of the completed studies found differences in pregnancy or perinatal outcomes associated with PrEP exposure. Nine ongoing studies, to be completed by 2022, will provide data on >6200 additional PrEP-exposed pregnancies and assess perinatal, infant growth and bone health outcomes, expanding by sixfold the data on PrEP safety in pregnancy. Research gaps include limited data on (1) accurately measured PrEP exposure within maternal and infant populations including drug levels needed for maternal protection; (2) uncommon perinatal outcomes (e.g. congenital anomalies); (3) infant outcomes such as bone growth beyond one year following PrEP exposure; (4) outcomes in HIV-uninfected women who use PrEP during pregnancy and/or lactation. CONCLUSIONS Expanding delivery of PrEP is an essential strategy to reduce HIV incidence in pregnancy and breastfeeding women. Early safety studies of PrEP among pregnant women without HIV infection are reassuring and ongoing/planned studies will contribute extensive new data to bolster the safety profile of PrEP use in pregnancy. However, addressing research gaps is essential to expanding PrEP delivery for women in the context of pregnancy.
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Affiliation(s)
- Dvora L Joseph Davey
- Department of EpidemiologyFielding School of Public HealthUniversity of CaliforniaLos AngelesCAUSA
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Jillian Pintye
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Jared M Baeten
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
- Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Grace Aldrovandi
- Geffen School of MedicineUniversity of CaliforniaLos AngelesCAUSA
| | | | - Linda‐Gail Bekker
- Faculty of Health SciencesDesmond Tutu HIV CentreInstitute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownNCSouth Africa
| | - Connie Celum
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
| | - Benjamin H Chi
- Department of Obstetrics and GynecologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Thomas J Coates
- Geffen School of MedicineUniversity of CaliforniaLos AngelesCAUSA
| | | | - Renee Heffron
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - John Kinuthia
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | | | - James McIntyre
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
- ANOVAJohannesburgSouth Africa
| | - Dhayendre Moodley
- Department of Obstetrics and GynaecologyUniversity of KwaZulu‐NatalDurbanSouth Africa
- Centre for AIDS Research in South AfricaDurbanSouth Africa
| | | | - Nelly Mugo
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Center for Clinical ResearchKenya Medical Research Institute (KEMRI)NairobiKenya
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Andrew Mujugira
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Infectious Diseases InstituteMakerere UniversityKampalaUganda
| | - Steven Shoptaw
- Geffen School of MedicineUniversity of CaliforniaLos AngelesCAUSA
- Department of Family MedicineUniversity of CaliforniaLos AngelesCAUSA
| | | | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWAUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
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Abstract
Substance use during pregnancy is common, costly and associated with maternal and newborn health consequences. Assessment of substance use should be integrated into prenatal care. Substance use identification methods include patient interview, screening instruments, and biological testing. In this review, we critically evaluate screening and testing for substance use during pregnancy, highlighting the benefits and barriers of integrated assessment into prenatal care. We also discuss the limitations and negative consequences that should be considered when implementing screening and/or testing procedures. Lastly, we provide recommendations for the ethical implementation of screening and testing for substance use in the context of prenatal care.
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van Donge T, Evers K, Koch G, van den Anker J, Pfister M. Clinical Pharmacology and Pharmacometrics to Better Understand Physiological Changes During Pregnancy and Neonatal Life. Handb Exp Pharmacol 2019; 261:325-337. [PMID: 30968215 DOI: 10.1007/164_2019_210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pregnant women, fetuses, and newborns are particularly vulnerable patient populations. During pregnancy, the body is subject to physiological changes that influence the pharmacokinetics and pharmacodynamics of drugs. Inappropriate dosing in pregnant women can result in sub-therapeutic or toxic effects, putting not only the pregnant woman but also her fetus at risk. During neonatal life, maturation processes also affect pharmacokinetics and pharmacodynamics of drugs. Inappropriate dosing in newborns leads not only to short-term complications but can also have a negative impact on the long-term development of infants and children. For these reasons, it is crucial to characterize physiological changes in pregnant women, describe placental transfer kinetics of drugs, and describe physiological changes related to the transition from intrauterine to extrauterine life and maturation processes in preterm and term neonates. Quantitative pharmacological approaches such as pharmacometric and physiologically-based modeling and model-based simulations can be useful to better understand and predict such physiological changes and their effects on drug exposure and response. This review article (1) gives an overview of physiological changes in pregnant women, their fetuses, and (pre)term neonates, (2) presents case studies to illustrate applications of new modeling and simulation approaches, and (3) discusses challenges and opportunities in optimizing and personalizing treatments during pregnancy and neonatal life.
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Affiliation(s)
- Tamara van Donge
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.
| | - Katrina Evers
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Gilbert Koch
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - John van den Anker
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,Certara LP, Princeton, NJ, USA
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Perceptions, Practices, and Mother’s Willingness to Provide Meconium for Use in the Assessment of Environmental Exposures among Children in Mukono and Pallisa Districts, Uganda. ADVANCES IN PUBLIC HEALTH 2018. [DOI: 10.1155/2018/5691323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Presence of biomarkers or metabolites is assessed in various human biospecimens including meconium in the investigation of exposures to environmental contaminants. This study gathered data on the perceptions and practices of mothers in two rural districts of Uganda concerning meconium and their willingness to provide meconium from their babies for research purposes. The study reveals a wide range of perceptions and beliefs around meconium as well as a number of associated taboos and practices. Many participants noted that meconium could be used to detect ailments among newborns based on its appearance. Practices and beliefs included using it to prevent stomach discomfort and other ailments of newborns, as a means to confirm paternity and initiate the child into the clan as well as facilitating father-child bonding that included ingestion of meconium by the fathers. Most mothers indicated scepticism in accepting to provide meconium for research purposes and had fears of unscrupulous people disguising as researchers and using meconium to harm their children. However, some were willing to provide meconium, if it helped to detect ailments among their children. These perceptions and practices may negatively influence mothers’ willingness to participate in meconium study. However, through provision of educational and behaviour change interventions, mothers’ willingness to participate in a meconium study can be improved.
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6
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Carson G, Cox LV, Crane J, Croteau P, Graves L, Kluka S, Koren G, Martel MJ, Midmer D, Nulman I, Poole N, Senikas V, Wood R. Archivée: No 245-Directive clinique de consensus sur la consommation d’alcool et la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e255-e292. [DOI: 10.1016/j.jogc.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Carson G, Cox LV, Crane J, Croteau P, Graves L, Kluka S, Koren G, Martel MJ, Midmer D, Nulman I, Poole N, Senikas V, Wood R. No. 245-Alcohol Use and Pregnancy Consensus Clinical Guidelines. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e220-e254. [DOI: 10.1016/j.jogc.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Ethyl linolenate is elevated in meconium of very-low-birth-weight neonates exposed to alcohol in utero. Pediatr Res 2017; 81:461-467. [PMID: 27828937 PMCID: PMC5373972 DOI: 10.1038/pr.2016.237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/07/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The health implications of in utero alcohol exposure have been difficult to study in very-low-birth-weight newborns (VLBW) because of an inability to identify maternal alcohol exposure. Fatty acid ethyl esters (FAEEs) are elevated in meconium of alcohol-exposed term newborns. We hypothesized that meconium FAEEs would be similarly elevated in alcohol-exposed VLBW premature newborns. METHODS In a retrospective cohort study of 64 VLBW neonates, newborns were classified into Non-Exposed, Any Exposure, or Weekly Exposure groups based on an in-depth structured maternal interview. Meconium FAEE concentrations were quantified via gas chromatography mass spectrometry. RESULTS Alcohol exposure during Trimester 1 (Any Exposure) occurred in ~30% of the pregnancies, while 11% of the subjects reported drinking ≥ 1 drink/week (Weekly Exposure). Meconium ethyl linolenate was higher in Any Exposure (P = 0.01) and Weekly Exposure groups (P = 0.005) compared to the Non-Exposed VLBW group. There was a significant positive correlation between Trimester 1 drinking amounts and the concentration of meconium ethyl linolenate (P = 0.005). Adjusted receiver operating characteristic (ROC) curves evaluating ethyl linolenate to identify alcohol-exposed VLBW newborns generated areas under the curve of 88% with sensitivities of 86-89% and specificities of 83-88%. CONCLUSION Despite prematurity, meconium FAEEs hold promise to identify the alcohol-exposed VLBW newborn.
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9
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Frey AJ, Park BY, Schriver ER, Feldman DR, Parry S, Croen LA, Fallin DM, Hertz-Picciotto I, Newschaffer CJ, Snyder NW. Differences in testosterone and its precursors by sex of the offspring in meconium. J Steroid Biochem Mol Biol 2017; 167:78-85. [PMID: 27871978 PMCID: PMC5292277 DOI: 10.1016/j.jsbmb.2016.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/07/2016] [Accepted: 11/14/2016] [Indexed: 01/13/2023]
Abstract
Prenatal metabolism exerts profound effects on development. The first stool of the newborn, meconium, provides a window into the prenatal metabolic environment. The objective of this study was to examine the feasibility of meconium as a novel matrix to quantify prenatal steroid levels. We quantified parameters of analytical interest regarding the use of meconium, including sample stability. We hypothesized that meconium steroid content would differ by sex, prompting analysis of meconium to test effects of prenatal steroid metabolism. Meconium from 193 newborns enrolled in the Early Autism Risk Longitudinal Investigation (EARLI) study, including 107 males, and 86 females, were analyzed by isotope dilution-liquid chromatography-high resolution mass spectrometry (ID-LC-HRMS) while blinded to identity for testosterone (T), androstenedione (AD), and dehydroepiandrosterone (DHEA). Steroid levels were compared by sex, and investigations of potential trends resulting from sample storage or processing was conducted. The unconjugated steroid content of meconium in ng/g (mean, standard deviation) was for males: T (2.67, 8.99), AD (20.01, 28.12), DHEA (13.96, 23.57) and for females: T (0.82, 1.63), AD (22.32, 24.38), DHEA (21.06, 43.49). T was higher in meconium from males (p=0.0333), and DHEA was higher in meconium from females (p=0.0202). 6 female and 3 male T values were below the limit of detection. No extreme variability in hydration or trend in steroid levels by storage time was detected. Sexually dimorphic levels of hormones may reflect gestational differentiation, and future studies should consider meconium analysis.
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Affiliation(s)
- Alexander J Frey
- AJ Drexel Autism Institute, Drexel University, 3020 Market St, Suite 560, Philadelphia, PA 19104, USA
| | - Bo Y Park
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, HH884 Baltimore, MD 21205, USA
| | - Emily R Schriver
- AJ Drexel Autism Institute, Drexel University, 3020 Market St, Suite 560, Philadelphia, PA 19104, USA
| | - Daniel R Feldman
- AJ Drexel Autism Institute, Drexel University, 3020 Market St, Suite 560, Philadelphia, PA 19104, USA
| | - Samuel Parry
- Maternal Fetal Medicine Division, University of Pennsylvania School of Medicine, 2000 Courtyard Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lisa A Croen
- Autism Research Program, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Daniele M Fallin
- Wendy Klag Center for Autism and Developmental Disabilities, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, HH 850, Baltimore, MD 21205, USA
| | - Irva Hertz-Picciotto
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, Department of Public Health Sciences, School of Medicine, University of California, Davis, USA
| | - Craig J Newschaffer
- AJ Drexel Autism Institute, Drexel University, 3020 Market St, Suite 560, Philadelphia, PA 19104, USA
| | - Nathaniel W Snyder
- AJ Drexel Autism Institute, Drexel University, 3020 Market St, Suite 560, Philadelphia, PA 19104, USA.
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10
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Ramirez J, Elmofty M, Castillo E, DeRouen M, Shariff-Marco S, Allen L, Gomez SL, Nápoles AM, Márquez-Magaña L. Evaluation of cortisol and telomere length measurements in ethnically diverse women with breast cancer using culturally sensitive methods. J Community Genet 2017; 8:75-86. [PMID: 28050886 PMCID: PMC5386910 DOI: 10.1007/s12687-016-0288-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
The under-representation of ethnic minority participants, who are more likely to be socially disadvantaged in biomedical research, limits generalizability of results and reductions in health disparities. To facilitate investigations of how social disadvantage “gets under the skin,” this pilot study evaluated low-intensity methods for collecting hair and saliva samples from multiethnic breast cancer survivors (N = 70) and analysis of biomarkers of chronic stress (cortisol levels) and biological age (telomere length). Methods allowed for easy self-collection of hair (for cortisol) and saliva (for telomere lengths) samples that were highly stable for shipment and long-term storage. Measuring cortisol in hair as a biomarker of chronic stress was found to overcome many of the limitations of salivary cortisol measurements, and the coefficient of variation obtained using an ELISA-based approach to measure cortisol was within acceptable standards (16%). Telomere length measurements obtained using a qPCR approach had a coefficient of variation of <10% when the DNA extracted from the saliva biospecimens was of sufficient quantity and quality (84%). The overall response rate was 47%; rates were 32% for African-Americans, 39% for Latinas, 40% for Asians, and 82% for non-Latina Whites. Self-collection of hair and saliva overcame cultural and logistical barriers associated with collection of blood. Results support the use of these biospecimen collection and analysis methods among ethnically diverse and disadvantaged populations to identify biopsychosocial pathways of health disparities. Our tools should stimulate research to better understand how social disadvantage “gets under the skin” and increase participation of ethnic minorities in biomedical research.
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Affiliation(s)
- Julio Ramirez
- Health Equity Research Laboratory, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
| | - May Elmofty
- Health Equity Research Laboratory, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
| | - Esperanza Castillo
- Health Equity Research Laboratory, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
| | - Mindy DeRouen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite #300, Fremont, CA, 94538, USA.,Stanford Cancer Institute, Lorry Lokey Building/SIM 1, 265 Campus Drive, Ste G2103, Stanford, CA, 94305, USA
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite #300, Fremont, CA, 94538, USA.,Stanford Cancer Institute, Lorry Lokey Building/SIM 1, 265 Campus Drive, Ste G2103, Stanford, CA, 94305, USA
| | - Laura Allen
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite #300, Fremont, CA, 94538, USA
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite #300, Fremont, CA, 94538, USA.,Stanford Cancer Institute, Lorry Lokey Building/SIM 1, 265 Campus Drive, Ste G2103, Stanford, CA, 94305, USA
| | - Anna María Nápoles
- Center for Aging in Diverse Communities, Division of General Internal Medicine, Department of Medicine and the Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - Leticia Márquez-Magaña
- Health Equity Research Laboratory, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA.
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11
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Ethical and social challenges in newborn screening for prenatal alcohol exposure. Can J Neurol Sci 2016; 41:115-8. [PMID: 24384352 DOI: 10.1017/s0317167100016413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Abstract
Gestational substance exposure continues to be a significant problem. Neonates may be exposed to various substances including illicit drugs, prescription drugs, and other legal substances that are best not used during pregnancy because of their potential deleterious effects as possible teratogens or their potential to create dependence and thus withdrawal in the neonate. Screening the newborn for gestational substance exposure is important for both acute care and early intervention to promote the best possible long-term outcomes. This column provides insight into what is known about the extent of substance use by pregnant women, an overview of neonatal biologic matrices for drug testing, and a discussion of the legal implications of neonatal substance screening.
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14
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Konijnenberg C, Melinder A. Executive function in preschool children prenatally exposed to methadone or buprenorphine. Child Neuropsychol 2014; 21:570-85. [DOI: 10.1080/09297049.2014.967201] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Park BY, Lee BK. Use of meconium in perinatal epidemiology: potential benefits and pitfalls. Ann Epidemiol 2014; 24:878-81. [PMID: 25444889 DOI: 10.1016/j.annepidem.2014.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/12/2014] [Accepted: 09/15/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Meconium is a biomarker matrix that can be used to assess cumulative exposures in epidemiologic studies of prenatal risk factors. Depending on when meconium is collected, different exposure windows during pregnancy can be measured. However, little guidance exists regarding the extent to which timing of meconium collection will influence resulting effect estimates. METHODS We performed a simulation study of prenatal tobacco smoke exposure (assessed from meconium nicotine) and birth weight. We discuss four typical meconium collection methods capturing different exposure windows and assess the biases induced by these methods. RESULTS In simulations assuming that exposure to tobacco smoke only during late gestation was of etiologic relevance to birth weight, use of a meconium collection method that captured exposure windows other than late gestation resulted in biased estimates of the true nicotine-birth weight association. CONCLUSIONS Using meconium collection methods that do not reflect an exposure window of etiologic relevance can lead to biased results and erroneous conclusions regarding the nature of prenatal exposure-outcome associations. Understanding how prenatal exposure patterns vary across the pregnancy and exposure windows of etiologic relevance is essential in determining when and how to collect meconium for use in biomarker studies of prenatal exposure.
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Affiliation(s)
- Bo Y Park
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA.
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
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16
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Etwel F, Hutson JR, Madadi P, Gareri J, Koren G. Fetal and Perinatal Exposure to Drugs and Chemicals: Novel Biomarkers of Risk. Annu Rev Pharmacol Toxicol 2014; 54:295-315. [DOI: 10.1146/annurev-pharmtox-011613-135930] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fatma Etwel
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada M5G 1X8;
| | - Janine R. Hutson
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada M5G 1X8;
| | - Parvaz Madadi
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada M5G 1X8;
| | - Joey Gareri
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada M5G 1X8;
| | - Gideon Koren
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada M5G 1X8;
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17
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Delano K, Gareri J, Koren G. Rates of fetal polydrug exposures in methadone-maintained pregnancies from a high-risk population. PLoS One 2013; 8:e82647. [PMID: 24312668 PMCID: PMC3846722 DOI: 10.1371/journal.pone.0082647] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022] Open
Abstract
Methadone maintenance treatment (MMT) is the standard of care during pregnancy for opioid-dependency, showing efficacy in improving prenatal care and reducing risk of relapse. By design, however, MMT is only intended to prevent withdrawal thus facilitating cognitive behavioural interventions. In order to maximize the benefits of MMT, it is essential that methadone is both properly prescribed and that additional addiction treatment is concurrently administered. This study aims to determine the effectiveness of MMT engagement in high-risk pregnant women in reducing polydrug use by objective laboratory examination of neonatal meconium.
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Affiliation(s)
- Kaitlyn Delano
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Joey Gareri
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Gideon Koren
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
- * E-mail:
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Zelner I, Kenna K, Brien JF, Bocking A, Harding R, Walker D, Koren G. Meconium fatty acid ethyl esters as biomarkers of late gestational ethanol exposure and indicator of ethanol-induced multi-organ injury in fetal sheep. PLoS One 2013; 8:e59168. [PMID: 23533604 PMCID: PMC3606447 DOI: 10.1371/journal.pone.0059168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 02/13/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Meconium fatty acid ethyl esters (FAEE) constitute a biomarker of heavy fetal ethanol exposure. Our objective was to measure meconium FAEE in fetal sheep following daily, relatively moderate-dose ethanol exposure in late gestation, and to evaluate their utility in identifying fetal organ-system injury. METHODS Pregnant ewes received ethanol (0.75 g/kg; n = 14) or saline (n = 8) via 1-h i.v. infusion daily during the third trimester equivalent, while additional pregnant sheep served as untreated controls (n = 6). The daily ethanol regimen produced similar maximal maternal and fetal plasma ethanol concentrations of 0.11-0.12 g/dL. Ewes and fetuses were euthanized shortly before term, and meconium was collected and analyzed for FAEE (ethyl palmitate, stearate, linoleate, and oleate). RESULTS Meconium total FAEE concentration was significantly higher in ethanol-exposed fetuses compared with controls, and a positive cut-off of 0.0285 nmol total FAEE/g meconium had 93.3% sensitivity and specificity for detecting fetal ethanol exposure. When the studied animals (ethanol-exposed and controls) were classified according to meconium FAEE concentration, FAEE-positive and FAEE-negative groups frequently differed with respect to previously examined pathological endpoints, including nephron endowment, lung collagen deposition, cardiomyocyte maturation, and tropoelastin gene expression in cerebral vessels. Furthermore, in all studied animals as a group (ethanol-exposed and controls combined), meconium FAEE concentration was correlated with many of these pathological endpoints in fetal organs. CONCLUSIONS We conclude that, in fetal sheep, meconium FAEE could serve as a biomarker of daily ethanol exposure in late gestation and could identify fetuses with subtle ethanol-induced toxic effects in various organs. This study illustrates the potential for using meconium FAEE to identify neonates at risk for dysfunction of major organs following in-utero ethanol exposure that does not result in overt physical signs of ethanol teratogenicity.
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Affiliation(s)
- Irene Zelner
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario
| | - Kelly Kenna
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - James F. Brien
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Alan Bocking
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Richard Harding
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - David Walker
- Ritchie Centre for Infant Health, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Gideon Koren
- Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario
- * E-mail:
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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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Koren G. Treating the Mother, Protecting the Unborn: The Motherisk Approach. J Pediatr Pharmacol Ther 2013; 18:4-7. [DOI: 10.5863/1551-6776-18.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pregnant women and their unborn babies are excluded from most pharmaceutical research. We have to convince regulatory agencies worldwide that, by not demanding research of drug safety and effectiveness in pregnancy from pharmaceutical agencies, we are orphaning pregnant women from progress in therapeutics and causing both themselves and their unborn babies tremendous unacceptable risks.
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Affiliation(s)
- Gideon Koren
- The Motherisk Program, Division of Clinical Pharmacology, the Hospital for Sick Children, Toronto, Canada
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Delano K, Koren G. Emerging biomarkers of intrauterine neonatal and pediatric exposures to xenobiotics. Pediatr Clin North Am 2012; 59:1059-70. [PMID: 23036244 DOI: 10.1016/j.pcl.2012.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Biomarkers are an important tool for clinicians to detect long-term exposure to a multitude of compounds, including drugs of abuse, alcohol, and environmental toxicants. Using hair and meconium as matrices for biomarker testing provides a longer window of detection than that of blood or urine, providing clinically relevant information on prenatal exposures. The use of biomarkers can aid clinicians in early diagnosis and implementing appropriate interventions. The increasing burden of environmental toxicants has warranted the development of biomarkers for specific compounds, which could decrease exposure in humans.
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Affiliation(s)
- Kaitlyn Delano
- Department of Pharmacology, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada
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Zelner I, Shor S, Lynn H, Roukema H, Lum L, Eisinga K, Koren G. Neonatal screening for prenatal alcohol exposure: assessment of voluntary maternal participation in an open meconium screening program. Alcohol 2012; 46:269-76. [PMID: 22440689 DOI: 10.1016/j.alcohol.2011.09.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/12/2011] [Accepted: 09/23/2011] [Indexed: 11/15/2022]
Abstract
Meconium fatty acid ethyl esters (FAEEs) are validated biomarkers of fetal alcohol exposure. Meconium FAEE testing can potentially be used as a screen by health-care professionals to identify neonates at-risk for Fetal Alcohol Spectrum Disorder, thereby permitting diagnostic follow-up of these children and early intervention in those who develop disabilities. The purpose of this study was to assess whether women would willingly partake in a screening program of this nature. This was determined by launching a pilot screening program for prenatal alcohol exposure in a high-risk obstetric unit previously shown to have a high prevalence of FAEE-positive meconium via anonymous meconium testing. The program involved voluntary testing of meconium for FAEEs and long-term developmental follow-up of positive cases through an existing public health program. The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%, respectively; p < 0.05), and the positivity rate was 3% in contrast to 30% observed under anonymous conditions (p < 0.001). These low rates suggest that the majority of mothers who consumed alcohol in pregnancy refused to participate. We conclude that despite the potential benefits of such screening programs, maternal unwillingness to consent, likely due to fear, embarrassment, and guilt, may limit the effectiveness of meconium testing for population-based open screening, highlighting the need for public education and social marketing efforts for such programs to be of benefit.
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Affiliation(s)
- Irene Zelner
- Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Zelner I, Hutson JR, Kapur BM, Feig DS, Koren G. False-Positive Meconium Test Results for Fatty Acid Ethyl Esters Secondary to Delayed Sample Collection. Alcohol Clin Exp Res 2012; 36:1497-506. [DOI: 10.1111/j.1530-0277.2012.01763.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 01/13/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Denice S. Feig
- Division of Endocrinology; Department of Medicine; Mount Sinai Hospital; University of Toronto; Toronto; Ontario; Canada
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Abstract
Abstract
BACKGROUND
Emerging antenatal interventions and care delivery to the fetus require diagnostic support, including laboratory technologies, appropriate methodologies, establishment of special algorithms, and interpretative guidelines for clinical decision-making.
CONTENT
Fetal diagnostic and therapeutic interventions vary in invasiveness and are associated with a spectrum of risks and benefits. Fetal laboratory assessments are well served by miniaturized diagnostic methods for blood analysis. Expedited turnaround times are mandatory to support invasive interventions such as cordocentesis and intrauterine transfusions. Health-associated reference intervals are required for fetal test interpretation. Fetal blood sampling by cordocentesis carries substantial risk and is therefore performed only when fetal health is impaired, or at risk. When the suspected pathology is not confirmed, however, normative fetal data can be collected. Strategies for assurance of sample integrity from cordocenteses and confirmation of fetal origin are described. After birth, definitive assessment of prenatal environmental and/or drug exposures to the fetus can be retrospectively assessed by analysis of meconium, hair, and other alternative matrices. A rapidly advancing technology for fetal assessment is the use of fetal laboratory diagnostic techniques that use cell-free fetal DNA collected from maternal plasma, and genetic analysis based on molecular counting techniques.
SUMMARY
Developmental changes in fetal biochemical and hematologic parameters in health and disease are continually delineated by analysis of our collective outcome-based experience. Noninvasive technologies for fetal evaluation are realizing the promise of lower risk yet robust diagnostics; examples include sampling and analysis of free fetal DNA from maternal blood, and analysis of fetal products accessible at maternal sites. Application of diagnostic technologies for nonmedical purposes (e.g., sex selection) underscores the importance of ethical guidelines for new technology implementation.
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Affiliation(s)
- Sharon M Geaghan
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California
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Koren G, Nulman I, Aleksa K, Gareri J, Einarson A, Ito S. Essay for the 2011 CIHR/CMAJ award: Motherisk--caring for mothers, protecting the unborn. CMAJ 2012; 184:E155-7. [PMID: 22271922 DOI: 10.1503/cmaj.112128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Gideon Koren
- Motherisk Program, Hospital for Sick Children, University of Toronto, Toronto, Ont.
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Abstract
An increasing number of toxicology laboratories are choosing to expand the services they offer to include hair testing in response to customer demands. Hair provides the toxicologist with many advantages over conventional matrices in that it is easy to collect, is a robust and stable matrix that does not require refrigeration, and most importantly, provides a historical profile of an individual's exposure to drugs or analytes of interest. The establishment of hair as a complementary technique in forensic toxicology is a direct result of the success of the matrix in medicolegal cases and the wide range of applications. However, before introducing hair testing, laboratories must consider what additional requirements they will need that extend beyond simply adapting methodologies already validated for blood or urine. Hair presents many challenges with respect to the lack of available quality control materials, extensive sample handling protocols and low drug concentrations requiring greater instrument sensitivity. Unfortunately, a common pitfall involves over-interpretation of the findings and must be avoided.
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Dinis-Oliveira RJ, Carvalho F, Duarte JA, Remião F, Marques A, Santos A, Magalhães T. Collection of biological samples in forensic toxicology. Toxicol Mech Methods 2010; 20:363-414. [PMID: 20615091 DOI: 10.3109/15376516.2010.497976] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Forensic toxicology is the study and practice of the application of toxicology to the purposes of the law. The relevance of any finding is determined, in the first instance, by the nature and integrity of the specimen(s) submitted for analysis. This means that there are several specific challenges to select and collect specimens for ante-mortem and post-mortem toxicology investigation. Post-mortem specimens may be numerous and can endow some special difficulties compared to clinical specimens, namely those resulting from autolytic and putrefactive changes. Storage stability is also an important issue to be considered during the pre-analytic phase, since its consideration should facilitate the assessment of sample quality and the analytical result obtained from that sample. The knowledge on degradation mechanisms and methods to increase storage stability may enable the forensic toxicologist to circumvent possible difficulties. Therefore, advantages and limitations of specimen preservation procedures are thoroughfully discussed in this review. Presently, harmonized protocols for sampling in suspected intoxications would have obvious utility. In the present article an overview is given on sampling procedures for routinely collected specimens as well as on alternative specimens that may provide additional information on the route and timing of exposure to a specific xenobiotic. Last, but not least, a discussion on possible bias that can influence the interpretation of toxicological results is provided. This comprehensive review article is intented as a significant help for forensic toxicologists to accomplish their frequently overwhelming mission.
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Affiliation(s)
- R J Dinis-Oliveira
- Institute of Legal Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.
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Opioid detection in maternal and neonatal hair and meconium: characterization of an at-risk population and implications to fetal toxicology. Ther Drug Monit 2010; 32:318-23. [PMID: 20418801 DOI: 10.1097/ftd.0b013e3181dca48b] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of a reliable self-report. We aimed to characterize an at-risk neonatal population for opioid exposures as well as other drugs of abuse and alcohol. From June 2007 to January 2009, 563 neonatal hair and 1318 meconium specimens were assessed for opioids and were positive in 11.4% and 17.0%, respectively. Neonates testing positive for opioids in hair or meconium analysis were also more likely to test positive for other licit and illicit substances (odds ratiohair, 1.75; 95% confidence interval, 1.03-2.97; odds ratiomeconium, 1.61; 95% confidence interval, 1.16-2.22). Specifically, a positive neonatal hair test for opioids also predicted a positive result for oxycodone. In addition, a positive meconium test result for opioids was associated with positive results for cocaine, oxycodone, methadone, benzodiazepines, and fatty acid ethyl esters (alcohol). Finally, there was a significant correlation between maternal and neonatal hair test results for opioids (Spearman rank rho = 0.657, P = 0.03). Understanding the addiction profiles of these women may lead to better clinical and social management and may largely benefit an at-risk population.
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Chapter 5 Recognition, Screening, and Documentation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010. [DOI: 10.1016/s1701-2163(16)34639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Universal Screening for Prenatal Alcohol Exposure: A Progress Report of a Pilot Study in the Region of Grey Bruce, Ontario. Ther Drug Monit 2010; 32:305-10. [DOI: 10.1097/ftd.0b013e3181dca381] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burns E, Gray R, Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: a systematic review. Addiction 2010; 105:601-14. [PMID: 20403013 DOI: 10.1111/j.1360-0443.2009.02842.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS Although prenatal screening for problem drinking during pregnancy has been recommended, guidance on screening instruments is lacking. We investigated the sensitivity, specificity and predictive value of brief alcohol screening questionnaires to identify problem drinking in pregnant women. METHODS Electronic databases from their inception to June 2008 were searched, as well as reference lists of eligible papers and related review papers. We sought cohort or cross-sectional studies that compared one or more brief alcohol screening questionnaire(s) with reference criteria obtained using structured interviews to detect 'at-risk' drinking, alcohol abuse or dependency in pregnant women receiving prenatal care. RESULTS Five studies (6724 participants) were included. In total, seven instruments were evaluated: TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Kut down), T-ACE [Take (number of drinks), Annoyed, Cut down, Eye-opener], CAGE (Cut down, Annoyed, Guilt, Eye-opener], NET (Normal drinker, Eye-opener, Tolerance), AUDIT (Alcohol Use Disorder Identification Test), AUDIT-C (AUDIT-consumption) and SMAST (Short Michigan Alcohol Screening Test). Study quality was generally good, but lack of blinding was a common weakness. For risk drinking sensitivity was highest for T-ACE (69-88%), TWEAK (71-91%) and AUDIT-C (95%), with high specificity (71-89%, 73-83% and 85%, respectively). CAGE and SMAST performed poorly. Sensitivity of AUDIT-C at score >or=3 was high for past year alcohol dependence (100%) or alcohol use disorder (96%) with moderate specificity (71% each). For life-time alcohol dependency the AUDIT at score >or=8 performed poorly. CONCLUSION T-ACE, TWEAK and AUDIT-C show promise for screening for risk drinking, and AUDIT-C may also be useful for identifying alcohol dependency or abuse. However, their performance as stand-alone tools is uncertain, and further evaluation of questionnaires for prenatal alcohol use is warranted.
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Affiliation(s)
- Ethel Burns
- School of Health and Social Care, Oxford Brookes University, Jack Straws Lane, Marston, Oxford, UK
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Reproductive and Developmental Toxicity. Clin Toxicol (Phila) 2010. [DOI: 10.3109/9781420092264-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sympathomimetics. Clin Toxicol (Phila) 2010. [DOI: 10.3109/9781420092264-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Pediatricians and other medical providers caring for children need to be aware of the dynamics in the significant relationship between substance abuse and child maltreatment. A caregiver's use and abuse of alcohol, marijuana, heroin, cocaine, methamphetamine, and other drugs place the child at risk in multiple ways. Members of the medical community need to understand these risks because the medical community plays a unique and important role in identifying and caring for these children. Substance abuse includes the abuse of legal drugs as well as the use of illegal drugs. The abuse of legal substances may be just as detrimental to parental functioning as abuse of illicit substances. Many substance abusers are also polysubstance users and the compounded effect of the abuse of multiple substances may be difficult to measure. Often other interrelated social features, such as untreated mental illness, trauma history, and domestic violence, affect these families.
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Koren G, Finkelstein Y, Matsui D, Berkovich M. Diagnosis and Management of Poor Neonatal Adaptation Syndrome in Newborns Exposed In Utero to Selective Seretonin/Norepinephrine Reuptake Inhibitors. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:348-350. [DOI: 10.1016/s1701-2163(16)34157-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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