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McMillin GA, Morad AW, Boyd JM, Johnson-Davis KL, Metz TD, Smid MC, Krasowski MD. Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure. Clin Chem 2024; 70:934-947. [PMID: 38549034 DOI: 10.1093/clinchem/hvae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/02/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Substance use during pregnancy is common, as is biological testing that is intended to help identify prenatal exposures. However, there is no standardized requirement for biological testing with either maternal or newborn specimens, nor is there standardization related to when testing occurs, how frequently testing occurs, what specimen(s) to test, what substances to test for, or how to perform testing. CONTENT We review common specimen types tested to detect maternal and newborn substance exposure with a focus on urine, meconium, and umbilical cord tissue. We also review common analytical methods used to perform testing, including immunoassay, and mass spectrometry platforms. Considerations regarding the utilization of testing relative to the purpose of testing, the drug analyte(s) of interest, the specific testing employed, and the interpretation of results are emphasized to help guide decisions about clinical utilization of testing. We also highlight specific examples of unexpected results that can be used to guide interpretation and appropriate next steps. SUMMARY There are strengths and limitations associated with all approaches to detecting substance exposure in pregnant persons as well as biological testing to evaluate a newborn with possible substance exposure. Standardization is needed to better inform decisions surrounding evaluation of substance exposures in pregnant people and newborns. If biological sampling is pursued, testing options and results must be reviewed in clinical context, acknowledging that false-positive and -negative results can and do occur.
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Affiliation(s)
- Gwendolyn A McMillin
- Department of Pathology and ARUP Laboratories, University of Utah Health, Salt Lake City, UT 84108, United States
| | - Anna W Morad
- Department of Pediatrics, Academic General Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Jessica M Boyd
- Department of Pathology and ARUP Laboratories, University of Utah Health, Salt Lake City, UT 84108, United States
| | - Kamisha L Johnson-Davis
- Department of Pathology and ARUP Laboratories, University of Utah Health, Salt Lake City, UT 84108, United States
| | - Torri D Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT 84132, United States
| | - Marcela C Smid
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT 84132, United States
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
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Lanier K, Wisseman B, Strom C, Johnston CA, Isler C, DeVente J, Newton E, Pawlak R, Allman-Tucker BR, McDonald S, May LE. Self-Reported Intake and Circulating EPA and DHA Concentrations in US Pregnant Women. Nutrients 2023; 15:1753. [PMID: 37049593 PMCID: PMC10097082 DOI: 10.3390/nu15071753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
In the United States, pregnant women have low concentrations of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are essential for fetal development. Although maternal blood provides accurate polyunsaturated fatty acid (PUFA) concentrations, venipuncture is expensive and not always accessible. PUFA-containing foods consumption, both omega-3 ad omega-6 is supposed to reflect in the status (plasma, RBC, adipose tissue) of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). De novo synthesis of DHA and EPA during pregnancy is supposed to be higher compared to pre and/or post-pregnancy periods. Thus, this study aimed to determine the association between maternal self-reported dietary intake of foods high in DHA and EPA, along with vegetable oils as a source of omega-6 fatty acids, with maternal blood DHA and EPA concentrations. Pregnant women (13-16 weeks gestation) were recruited and asked to complete a food-frequency questionnaire (FFQ) and blood draw at enrollment and 36 weeks. Circulating concentrations of DHA and EPA were quantified and change scores were calculated. Correlations were done to determine associations between FFQ results and EPA/DHA maternal blood concentrations. Regression analyses were run to examine significant predictors of the main outcomes. Overall, PUFA-food consumption and RBC's DHA levels decreased from early to late pregnancy; self-reported PUFA-rich food consumption positively correlated with DHA and EPA levels. DHA concentration was predicted by self-reported PUFA-rich oils (sunflower/soy/corn/olive) consumption, but EPA concentration was predicted by maternal BMI. These findings suggest that EPA and DHA consumption decreased across pregnancy and the FFQ can be utilized as an effective method for estimating PUFA blood concentration during pregnancy.
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Affiliation(s)
- Keri Lanier
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, USA
| | - Breanna Wisseman
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC 27858, USA
| | - Cody Strom
- Department of Kinesiology and Sport, University of Southern Indiana, Evansville, IN 47712, USA
| | - Carol A. Johnston
- Department of Human Development and Family Science, East Carolina University (ECU), Greenville, NC 27858, USA
| | - Christy Isler
- Department of Obstetrics and Gynecology, East Carolina University (ECU), Greenville, NC 27858, USA
| | - James DeVente
- Department of Obstetrics and Gynecology, East Carolina University (ECU), Greenville, NC 27858, USA
| | - Edward Newton
- Department of Obstetrics and Gynecology, East Carolina University (ECU), Greenville, NC 27858, USA
| | - Roman Pawlak
- Department of Nutrition, East Carolina University (ECU), Greenville, NC 27858, USA
| | | | - Samantha McDonald
- Kinesiology and Recreation, Illinois State University, Normal, IL 61790, USA
| | - Linda E. May
- Department of Kinesiology, East Carolina University (ECU), Greenville, NC 27858, USA
- Department of Obstetrics and Gynecology, East Carolina University (ECU), Greenville, NC 27858, USA
- East Carolina Diabetes and Obesity Institute, East Carolina University (ECU), Greenville, NC 27858, USA
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Albano GD, La Spina C, Pitingaro W, Milazzo V, Triolo V, Argo A, Malta G, Zerbo S. Intrauterine and Neonatal Exposure to Opioids: Toxicological, Clinical, and Medico-Legal Issues. TOXICS 2023; 11:toxics11010062. [PMID: 36668788 PMCID: PMC9866828 DOI: 10.3390/toxics11010062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 06/01/2023]
Abstract
Opioids have a rapid transplacental passage (i.e., less than 60 min); furthermore, symptoms characterize the maternal and fetal withdrawal syndrome. Opioid withdrawal significantly impacts the fetus, inducing worse outcomes and a risk of mortality. Moreover, neonatal abstinence syndrome (NAS) follows the delivery, lasts up to 10 weeks, and requires intensive management. Therefore, the prevention and adequate management of NAS are relevant public health issues. This review aims to summarize the most updated evidence in the literature regarding toxicological, clinical, and forensic issues of intrauterine exposure to opioids to provide a multidisciplinary, evidence-based approach for managing such issues. Further research is required to standardize testing and to better understand the distribution of opioid derivatives in each specimen type, as well as the clinically relevant cutoff concentrations in quantitative testing results. A multidisciplinary approach is required, with obstetricians, pediatricians, nurses, forensic doctors and toxicologists, social workers, addiction specialists, and politicians all working together to implement social welfare and social services for the baby when needed. The healthcare system should encourage multidisciplinary activity in this field and direct suspected maternal and neonatal opioid intoxication cases to local referral centers.
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Shan X, Zhang L, Yang B. Review of LC techniques for determination of methadone and its metabolite in the biological samples. Prep Biochem Biotechnol 2021; 51:953-960. [PMID: 34365899 DOI: 10.1080/10826068.2021.1952598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Methadone (MTD) is a synthetic analgesic drug used for treating opioid dependence and effectively used clinically for patients with severe pain. The abuse of MTD may lead to poisoning, disorder in the central nervous system and even death. The regular monitoring of MTD in biological matrices including serum, plasma and urine samples is an effective way to control abuse of MTD. In this manner, the selection of analytical monitoring of MTD in biological matrices is of paramount importance. This study was conducted to review high-performance liquid chromatography (HPLC) techniques carried out on MTD and its main metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in the biological samples during 2015-June 2021.
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Affiliation(s)
- Xiaoyue Shan
- Hangzhou Occupational Disease Prevention and Control Hospital, Hangzhou, China
| | - Lei Zhang
- Hangzhou Occupational Disease Prevention and Control Hospital, Hangzhou, China
| | - Bingsheng Yang
- Hangzhou Occupational Disease Prevention and Control Hospital, Hangzhou, China
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