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Blanchot A, Antal MC, Ameline A, Gheddar L, Arbouche N, Raul JS, Kintz P. Pregnancy denial and unplanned home delivery: Considerations about fetal death causes and maternal drug use imputability. Forensic Sci Int 2023; 342:111538. [PMID: 36543017 DOI: 10.1016/j.forsciint.2022.111538] [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: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
Determining fetal death causes is a complex problem for the forensic pathologist. Beyond the medico-legal context, the expert must be able to evaluate the viability of the fetus at the time of death, to eliminate in-utero fetal death and to determine if the death is related to a fetal, a maternal, a placental cause, or simply related to obstetrical complications. The authors present the case of a 21-year-old woman who unexpectedly gave birth to a fetus during a party. As pregnancy was not acknowledged by the mother (regular menstrual cycles and use of hormonal contraception), no obstetrical check-up had been performed. She would have presented violent abdominal pain and expelled a mass in the toilet. The fetus body, enclosed in the amniotic pouch, and the placenta were found in the toilet. A forensic autopsy was performed jointly by a forensic pathologist and a specialist in fetal pathology. Histological, toxicological and genetic samples were collected. Body morphometry and bone maturation indicated a gestational age of 31-32 weeks of amenorrhea. A significant asphyxia syndrome and non-specific multi-visceral congestion were noted at autopsy. Histological analysis of the fetal tissues revealed a lung and skeletal muscle maturation in accordance with the estimated term. At the brain level, there were signs of anoxia and abnormal cortical development with periventricular nodular heterotopia areas. The placenta microscopic analysis revealed acute chorioamniotitis, the probable cause of the premature fetal expulsion. Toxicological analyses revealed the presence of ecstasy (48 ng/mL) and its metabolite MDA (2 ng/mL) in fetal blood. Although negative in blood, THC-COOH tested positive in urine (9 ng/mL). The fetus was repetitively exposed to cannabis, as Δ9-THC tested positive in hair (51 pg/mg). Maternal hair analysis on 4 × 3 cm evidenced a long-term use of cannabis, while results support single massive exposure to ecstasy. In this article, the authors try to explain the reflexive pathway carried out to establish death causes and the maternal toxic consumption imputability on the cerebral malformations and fetal death. This case illustrates both the interest of toxicological analyses in cases of fetal death and the importance of a collaborative work between forensic and fetal pathologists and toxicologists, which appeared critical to answer in the best conditions to the magistrates questions, as well as to the bereaved families.
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Affiliation(s)
- Adeline Blanchot
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France.
| | - Maria Cristina Antal
- UF6349 Fœtopathologie, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Alice Ameline
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | - Laurie Gheddar
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | - Nadia Arbouche
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | | | - Pascal Kintz
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
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Arkell R, Lee E. Using meconium to establish prenatal alcohol exposure in the UK: ethical, legal and social considerations. JOURNAL OF MEDICAL ETHICS 2022; 49:medethics-2022-108170. [PMID: 35868663 DOI: 10.1136/jme-2022-108170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
An expanding policy framework aimed at monitoring alcohol consumption during pregnancy has emerged. The primary justification is prevention of harm from what is termed 'prenatal alcohol exposure' (PAE), by enabling more extensive diagnosis of the disability labelled fetal alcohol spectrum disorder (FASD). Here we focus on proposals to include biomarkers as a PAE 'screening tool', specifically those found in meconium (the first newborn excrement), which are discussed as an 'objective' measure of PAE.We ask the overarching question, 'Can routine screening of meconium to establish PAE be ethically or legally justified', and we answer, 'No'. To reach this conclusion, we discuss three areas. First, we consider the reasons why meconium screening should not be deemed 'typical' within the scope of accepted screening tools. We argue that given the aim and necessary timing of the screen, it cannot achieve what it promises. Second, we outline why patient autonomy and consent are not properly accounted for and cannot be reconciled with the 'routinisation' of the proposed 'screening'. Last, we outline why the benefit of such a screen is not clear, focusing on the significance of trust in healthcare professionals (HCP) for the best interests of the future child and pregnant woman.While recognising the adverse effects of heavy alcohol consumption during pregnancy, we emphasise the case for robust ethical, legal and social considerations and the central need for trust between HCP and patients in maternity care. We conclude the permissibility of meconium screening has not been proven, and it is not justified.
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Affiliation(s)
- Rachel Arkell
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, Stratford-upon-Avon, UK
| | - Ellie Lee
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
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Concheiro M, Gutierrez FM, Ocampo A, Lendoiro E, González-Colmenero E, Concheiro-Guisán A, Peñas-Silva P, Macías-Cortiña M, Cruz-Landeira A, López-Rivadulla M, de-Castro-Ríos A. Assessment of biological matrices for the detection of in utero cannabis exposure. Drug Test Anal 2021; 13:1371-1382. [PMID: 33750017 DOI: 10.1002/dta.3034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 01/01/2023]
Abstract
Cannabis consumption has been increasing worldwide among pregnant women. Due to the negative effects of prenatal cannabis exposure, it is necessary to develop an objective, sensitive, and specific method to determine cannabinoids use during pregnancy. In this study, we compared four different biological samples, maternal hair, meconium, umbilical cord, and placenta, for the detection of in utero cannabis exposure. The biological samples were collected from 627 mother-newborn dyads. All hair and meconium samples were analyzed, and umbilical cord and placenta if hair and/or meconium were positive for cannabinoids. Meconium and hair showed to complement each other, with an agreement between hair and meconium results of 96.7% but only 34.3% if just positive results were considered. Umbilical cord and placenta results showed a better agreement with meconium (91.3% and 92.6%, respectively) than with hair (39.1% and 34.6%, respectively). The predominant metabolites in meconium were 11-nor-carboxy-THC (THCCOOH) and 8,11-dihydroxy-THC (diOHTHC), and in umbilical cord and placenta was THCCOOH-glucuronide. Cannabidiol (CBD) and cannabinol (CBN) were detected in meconium but not in any umbilical cord or placenta. For the first time, prenatal marijuana exposure was analyzed and compared in paired hair, meconium, umbilical cord, and placental samples. Hair and meconium positivity rate was similar, but a more sensitive and specific analytical method for the hair may resolve discrepancies between the matrices. Umbilical cord and placenta may be considered suitable alternative matrices to meconium through the determination of THCCOOH-glucuronide as a biomarker of cannabis exposure.
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Affiliation(s)
- Marta Concheiro
- John Jay College of Criminal Justice, City University of New York, New York, NY, USA
| | | | - Alejandro Ocampo
- John Jay College of Criminal Justice, City University of New York, New York, NY, USA
| | - Elena Lendoiro
- Sección de Toxicología, Instituto de Ciencias Forenses, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Ana Concheiro-Guisán
- Sección de Neonatología, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Patricia Peñas-Silva
- Sección de Ginecología y Obstetricia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Macías-Cortiña
- Sección de Ginecología y Obstetricia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angelines Cruz-Landeira
- Sección de Toxicología, Instituto de Ciencias Forenses, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel López-Rivadulla
- Sección de Toxicología, Instituto de Ciencias Forenses, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana de-Castro-Ríos
- Sección de Toxicología, Instituto de Ciencias Forenses, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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El Marroun H, Bolhuis K, Franken IHA, Jaddoe VWV, Hillegers MH, Lahey BB, Tiemeier H. Preconception and prenatal cannabis use and the risk of behavioural and emotional problems in the offspring; a multi-informant prospective longitudinal study. Int J Epidemiol 2020; 48:287-296. [PMID: 30239742 DOI: 10.1093/ije/dyy186] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies of the long-term consequences of maternal cannabis use on child development beyond the neonatal period are sparse. In the current study, we use a multi-information approach to assess the association of prenatal cannabis exposure and child behavioural and emotional functioning. To explore the possible causal nature of the association, we investigated whether maternal tobacco and paternal cannabis use during pregnancy were also associated with child problems. METHODS The study population included children of a population-based birth cohort in The Netherlands (n = 5903). Information on parental cannabis use was collected using questionnaires; urine of mothers was analysed for the presence of cannabis metabolites. Child behavioural and emotional problems at approximately 7-10 years were measured using validated teacher-, child- and mother-reports. RESULTS Our findings show associations of maternal cannabis use during pregnancy with offspring externalising problems (B = 0.53; 95% CI: 0.29-0.77), but not with internalising problems (B = -0.10; 95% CI: -0.31-0.11). However, maternal cannabis use before pregnancy was also associated with offspring externalising problems (B = 0.27; 95% CI: 0.02-0.52). Further, cannabis use by the father was associated with child externalising problems (B = 0.36; 95% CI: 0.22-0.49) but not internalising problems. CONCLUSIONS Prenatal exposure to maternal cannabis use is specifically associated with offspring behavioural problems, but not emotional problems. This association is probably not due to an effect of intrauterine cannabis exposure on fetal development, because both maternal and paternal cannabis exposure during pregnancy were related to offspring externalising problems. Our findings suggest that the association can be explained through residual confounding, most likely through shared genetic vulnerabilities for parental cannabis use and offspring behavioural problems.
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Affiliation(s)
- Hanan El Marroun
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, CA, The Netherlands.,Department of Psychology, Education and Child Studies - Erasmus University Rotterdam, 3000 DR, The Netherlands.,The Department of Pediatrics, Erasmus MC, Rotterdam, CA, The Netherlands
| | - Koen Bolhuis
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,The Generation R Study Group, Erasmus MC, Rotterdam, CA, The Netherlands
| | - Ingmar H A Franken
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,Department of Psychology, Education and Child Studies - Erasmus University Rotterdam, 3000 DR, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, Rotterdam, CA, The Netherlands.,The Department of Pediatrics, Erasmus MC, Rotterdam, CA, The Netherlands.,The Department of Epidemiology Erasmus MC, Rotterdam, CA, The Netherlands
| | - Manon H Hillegers
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands
| | - Benjamin B Lahey
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Henning Tiemeier
- The Department of Child and Adolescent Psychiatry, Erasmus MC, Sophia Children's Hospital, Rotterdam, 3000 CB, The Netherlands.,The Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
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Bukiya AN. Physiology of the Endocannabinoid System During Development. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1162:13-37. [PMID: 31332732 DOI: 10.1007/978-3-030-21737-2_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The endocannabinoid (eCB) system comprises endogenously produced cannabinoids (CBs), enzymes of their production and degradation, and CB-sensing receptors and transporters. The eCB system plays a critical role in virtually all stages of animal development. Studies on eCB system components and their physiological role have gained increasing attention with the rising legalization and medical use of marijuana products. The latter represent exogenous interventions that target the eCB system. This chapter summarizes knowledge in the field of CB contribution to gametogenesis, fertilization, embryo implantation, fetal development, birth, and adolescence-equivalent periods of ontogenesis. The material is complemented by the overview of data from our laboratory documenting the functional presence of the eCB system within cerebral arteries of baboons at different stages of development.
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Affiliation(s)
- Anna N Bukiya
- Department of Pharmacology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.
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Ryan SA, Ammerman SD, O’Connor ME, Gonzalez L, Patrick SW, Quigley J, Walker LR, Meek JY, Johnston M, Stellwagen L, Thomas J, Ware J. Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes. Pediatrics 2018; 142:peds.2018-1889. [PMID: 30150209 DOI: 10.1542/peds.2018-1889] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Marijuana is one of the most widely used substances during pregnancy in the United States. Emerging data on the ability of cannabinoids to cross the placenta and affect the development of the fetus raise concerns about both pregnancy outcomes and long-term consequences for the infant or child. Social media is used to tout the use of marijuana for severe nausea associated with pregnancy. Concerns have also been raised about marijuana use by breastfeeding mothers. With this clinical report, we provide data on the current rates of marijuana use among pregnant and lactating women, discuss what is known about the effects of marijuana on fetal development and later neurodevelopmental and behavioral outcomes, and address implications for education and policy.
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Affiliation(s)
- Sheryl A. Ryan
- Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Seth D. Ammerman
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University and Teen Health Van, Stanford Children’s Health, Palo Alto, California
| | - Mary E. O’Connor
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado; and
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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7
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El Marroun H, Tiemeier H, Franken IHA, Jaddoe VWV, van der Lugt A, Verhulst FC, Lahey BB, White T. Prenatal Cannabis and Tobacco Exposure in Relation to Brain Morphology: A Prospective Neuroimaging Study in Young Children. Biol Psychiatry 2016; 79:971-9. [PMID: 26422004 DOI: 10.1016/j.biopsych.2015.08.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/25/2015] [Accepted: 08/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cannabis use during pregnancy has been associated with negative behavioral outcomes and psychopathology in offspring. However, there has been little research evaluating alterations in brain structure as a result of maternal cannabis use. In this prospective study, we investigated the association between prenatal cannabis exposure and brain morphology in young children. METHODS We matched 96 children prenatally exposed to tobacco only (without cannabis) with 113 unexposed control subjects on the basis of age and gender and subsequently selected 54 children exposed to prenatal cannabis (mostly combined with tobacco exposure). These children (aged 6 to 8 years) were part of a population-based study in the Netherlands, the Generation R Study, and were followed from pregnancy onward. We assessed brain volumetric measures and cortical thickness in magnetic resonance imaging scans using FreeSurfer. We performed vertexwise analyses in FreeSurfer and linear regression analyses adjusting for relevant covariates using Statistical Package for the Social Sciences. RESULTS Prenatal cannabis exposure was not associated with global brain volumes, such as total brain volume, gray matter volume, or white matter volume. However, prenatal cannabis exposure was associated with differences in cortical thickness: compared with nonexposed control subjects, cannabis-exposed children had thicker frontal cortices. Prenatal tobacco exposure compared with nonexposed control subjects was associated with cortical thinning, primarily in the superior frontal and superior parietal cortices. CONCLUSIONS Our findings suggest an association between prenatal cannabis exposure and cortical thickness in children. Further research is needed to explore the causal nature of this association.
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Affiliation(s)
- Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Generation R Study Group, Rotterdam, The Netherlands.
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Department of Psychiatry, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ingmar H A Franken
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Departments of Pediatrics, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands
| | - Benjamin B Lahey
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Tonya White
- Department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; Departments of Pediatrics, Rotterdam, The Netherlands
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8
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Madgula RM, Groshkova T, Mayet S. Illicit drug use in pregnancy: effects and management. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.10.54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Cannabis is a known risk factor for schizophrenia, although the exact neurobiological process through which the effects on psychosis occur is not well-understood. In this review, we attempt to develop and discuss a possible pathway for the development of psychosis. We examine the neurobiological changes due to cannabis to see if these changes are similar to those seen in schizophrenic patients the findings show similarities; however, these mere similarities cannot establish a 'cause-effect' relationship as a number of people with similar changes do not develop schizophrenia. Therefore, the 'transition-to-psychosis' due to cannabis, despite being a strong risk factor, remains uncertain based upon neurobiological changes. It appears that other multiple factors might be involved in these processes which are beyond neurobiological factors. Major advances have been made in understanding the underpinning of marijuana dependence, and the role of the cannabinoid system, which is a major area for targeting medications to treat marijuana withdrawal and dependence, as well as other addictions is of now, it is clear that some of the similarities in the neurobiology of cannabis and schizophrenia may indicate a mechanism for the development of psychosis, but its trajectories are undetermined.
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Affiliation(s)
- Amresh Shrivastava
- Department of Psychiatry, Elgin Early Intervention Program for Psychosis, University of Western Ontario, London, Ontario, Canada ; Mental Health Resource Foundation, Mumbai, Maharashtra, India
| | - Megan Johnston
- Department of Psychology, University of Toronto, St. George, Toronto, Canada
| | - Kristen Terpstra
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Yves Bureau
- Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada
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McGlone L, Mactier H, Hassan H, Cooper G. In utero drug and alcohol exposure in infants born to mothers prescribed maintenance methadone. Arch Dis Child Fetal Neonatal Ed 2013; 98:F542-4. [PMID: 23836138 DOI: 10.1136/archdischild-2013-304158] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To describe the prevalence of in utero alcohol and illicit drug exposure in infants born to mothers prescribed methadone in pregnancy, and to compare the accuracy of maternal interview with infant toxicology. METHODS Urine and meconium samples were collected from 56 infants born to mothers prescribed methadone during pregnancy and a confidential interview conducted soon after delivery. Samples were screened for drugs of misuse and meconium samples analysed for the presence of fatty acid ethyl esters (FAEEs) to detect prenatal alcohol exposure. RESULTS 91% of infants had been exposed to illicit drugs in utero, including opiates (73%), benzodiazepines (70%) and cannabinoids (59%). 47% of infants had elevated FAEEs. Meconium was more sensitive at detecting in utero drug exposure than urine toxicology (p<0.01 for opiates, benzodiazepines, cannabinoids) or maternal interview (p=0.03 for opiates, p<0.01 for cannabinoids). CONCLUSIONS The majority of infants born to mothers prescribed methadone during pregnancy are exposed to polysubstance misuse, and almost one-half additionally exposed to excess alcohol.
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Affiliation(s)
- Laura McGlone
- Neonatal Unit, Royal Hospital for Sick Children, , Glasgow, UK
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11
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Friguls B, Joya X, Garcia-Serra J, Gómez-Culebras M, Pichini S, Martinez S, Vall O, Garcia-Algar O. Assessment of exposure to drugs of abuse during pregnancy by hair analysis in a Mediterranean island. Addiction 2012; 107:1471-9. [PMID: 22296208 DOI: 10.1111/j.1360-0443.2012.03828.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study aims to estimate the prevalence of drug use by pregnant women living in Ibiza, using structured interviews and biomarkers in maternal hair. In addition, the potentially detrimental effects of maternal drug abuse on their newborns were investigated. Ibiza has a large international night-life resort associated with clubs, music and use of recreational drugs. DESIGN, SETTING AND PARTICIPANTS Hair samples were collected prospectively from January to March 2010 from a cohort of consecutive mothers after giving birth in the Hospital Can Misses in Ibiza. MEASUREMENTS Opiates, cocaine, cannabis, methadone, amphetamines, 3,4-methylenedioxymethamphetamine (MDMA) and their metabolites were detected in a 3-cm-long proximal segment of maternal hair corresponding to the last trimester of pregnancy by gas chromatography coupled to mass spectrometry (n = 107). Data on socio-demographic characteristics and on tobacco, alcohol, drugs of prescription and drugs of abuse consumption during pregnancy were collected using a structured questionnaire. FINDINGS Hair analysis showed an overall 16% positivity for drugs of abuse in the third trimester of pregnancy, with a specific prevalence of cannabis, cocaine, MDMA and opiates use of 10.3, 6.4, 0.9 and 0%, respectively. In the questionnaires, only 1.9% of mothers declared using drugs of abuse during pregnancy. Gestational drug of abuse consumption was associated with active tobacco smoking, a higher number of smoked cigarettes and the mother being Spanish. CONCLUSIONS Illicit drug use is substantially under-reported among pregnant women living in Ibiza, particularly among Spanish nationals. Voluntary, routine objective biological toxicology screening should be considered as part of routine examinations in antenatal clinics on this Mediterranean island.
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Affiliation(s)
- Bibiana Friguls
- Unitat de Recerca Infància i Entorn, Institut Municipal d'Investigació Mèdica, Parc de Salut Mar, Barcelona, Spain.
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12
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Mutihir J, Musa J, Daru P, Nyango D, Audu M. Substance abuse among antenatal patients at jos university teaching hospital, north central Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2012; 2:50-62. [PMID: 25452983 PMCID: PMC4170296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Substance use in this country, among pregnant women, is a recent phenomenon as our women embrace western culture. More worrisome is the current finding showing no 'safe' level of alcohol exposure for possible adverse effect or harm to the developing child to occur. AIMS AND OBJECTIVES To determine what substances are used and the prevalence of substance use among pregnant women attending the antenatal clinic of the Jos University Teaching Hospital, Jos, Northcentral Nigeria. DESIGN Cross-sectional study. SETTING Jos University Teaching Hospital. RESULTS A total of 557 women were administered the pre-tested questionnaire. The mean age was 29.1 years, with a range of 15 to 48 years. The prevalence rate of substance used among the pregnant women was 43.8%. In all, 244 of the 557 women were taking one substance or the other. About 61.9% of the women abuse Kolanuts. There was no significant difference in the age group between those who sue it and those who do not (p-value 0.7411). Other substances were chlorpheniramine 10.6%, alcohol 8.6%, diazepam 4.5% and promethazine 2.5%, cigarettes/tobacco 2.9%, phenobarbitone 2.9%, cocaine 2.5%, codeine 2.0%, and marijuana 1.6%. A significant number 22.8% admit to using other substances in pregnancy. The commonest reason given for substance use is to control nausea and vomiting of early pregnancy. CONCLUSION Nigerian pregnant women use and abuse a wide variety of substances and drugs during pregnancy just as their counterparts in the developed world. The high prevalence observed in this study was largely due to the consumption of locally available substances.
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Affiliation(s)
- Jt Mutihir
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos
| | - J Musa
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos
| | - Ph Daru
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos
| | - Dd Nyango
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos
| | - Md Audu
- Department of Psychiatry, Jos University Teaching Hospital, Jos, Nigeria
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Joya X, Gomez-Culebras M, Callejón A, Friguls B, Puig C, Ortigosa S, Morini L, Garcia-Algar O, Vall O. Cocaine use during pregnancy assessed by hair analysis in a Canary Islands cohort. BMC Pregnancy Childbirth 2012; 12:2. [PMID: 22230295 PMCID: PMC3277455 DOI: 10.1186/1471-2393-12-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 01/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug use during pregnancy is difficult to ascertain, and maternal reports are likely to be inaccurate. The aim of this study was to estimate the prevalence of illicit drug use among pregnant women by using maternal hair analysis. METHODS A toxicological analysis of hair was used to detect chronic recreational drug use during pregnancy. In 2007, 347 mother-infant dyads were included from the Hospital La Candelaria, Santa Cruz de Tenerife, Canary Islands (Spain). Data on socioeconomic characteristics and on substance misuse during pregnancy were collected using a structured questionnaire. Drugs of abuse: opiates, cocaine, cannabinoids and amphetamines were detected in maternal hair by immunoassay followed by gas chromatography-mass spectrometry for confirmation and quantitation. RESULTS Hair analysis revealed 2.6% positivity for cocaine and its metabolites. Use of cocaine during pregnancy was associated with unusual behaviour with potentially harmful effects on the baby. CONCLUSIONS The results of the study demonstrate significant cocaine use by pregnant women in Canary Islands. The data should be used for the purpose of preventive health and policy strategies aimed to detect and possibly to avoid in the future prenatal exposure to drugs of abuse.
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Affiliation(s)
- Xavier Joya
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
| | | | - Alicia Callejón
- Departamento de Cirugía Pediátrica, Universidad de Tenerife, Spain
| | - Bibiana Friguls
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carme Puig
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
| | - Sandra Ortigosa
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Luca Morini
- Department of Legal Medicine and Public Health, University of Pavia, Italy
| | - Oscar Garcia-Algar
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oriol Vall
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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14
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Abstract
Marijuana (Cannabis sativa) is the illicit drug most commonly used by two vulnerable populations relevant to neurodevelopment-pregnant women and teenagers. Human longitudinal studies have linked prenatal and adolescent cannabis exposure with long-term behavioral abnormalities as well as increased vulnerability to neuropsychiatric disorders in adulthood. Animal models provide a means of studying the neurobiological mechanisms underlying these long-term effects. This chapter provides an overview of the animal models we have used to study the developmental impact of cannabis.
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Affiliation(s)
- Jennifer A Dinieri
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
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15
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Morris CV, DiNieri JA, Szutorisz H, Hurd YL. Molecular mechanisms of maternal cannabis and cigarette use on human neurodevelopment. Eur J Neurosci 2011; 34:1574-83. [PMID: 22103415 PMCID: PMC3226730 DOI: 10.1111/j.1460-9568.2011.07884.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Prenatal development is highly sensitive to maternal drug use due to the vulnerability for disruption of the fetal brain with its ongoing neurodevelopment, resulting in lifelong consequences that can enhance risk for psychiatric disorders. Cannabis and cigarettes are the most commonly used illicit and licit substances, respectively, among pregnant women. Although the behavioral consequences of prenatal cannabis and cigarette exposure have been well-documented in epidemiological and clinical studies, only recently have investigations into the molecular mechanisms associated with the developmental impact of early drug exposure been addressed. This article reviews the literature relevant to long-term gene expression disturbances in the human fetal brain in relation to maternal cannabis and cigarette use. To provide translational insights, we discuss animal models in which protracted molecular consequences of prenatal cannabis and cigarette exposure can be better explored and which enable future evaluation of epigenetic pathways, such as DNA methylation and histone modification, that could potentially maintain abnormal gene regulation and related behavioral disturbances. Altogether, this information may help to address the current gaps of knowledge regarding the impact of early drug exposure that set in motion lifelong molecular disturbances that underlie vulnerability to psychiatric disorders.
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Affiliation(s)
- Claudia V Morris
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA
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16
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Étude de prévalence des conduites addictives chez les femmes enceintes dans une maternité universitaire. ACTA ACUST UNITED AC 2011; 40:237-45. [DOI: 10.1016/j.jgyn.2011.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 11/23/2022]
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17
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Scott K, Fagermo N, Callaway L, Lust K. Illicit drug use in late pregnancy associated with stillbirth and eclampsia. Obstet Med 2010; 3:113-4. [PMID: 27579073 DOI: 10.1258/om.2010.090061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2010] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 20-year-old student with an undiagnosed pregnancy who had taken ecstasy and LSD (lysergic acid diethylamide). Twenty-four hours later she delivered a stillborn term infant, and subsequently developed eclampsia with seizures, hypertension and proteinuria. Illicit drug use is relatively common in women of child-bearing age in Australia, and is a risk factor for adverse obstetric outcomes. Ecstasy (MDMA [3,4-methylenedioxymethamphetamine]) is a sympathomimetic amine, similar to amphetamine in its cardiovascular effects. LSD is a hallucinogen with complex pharmacology and has potential for significant compromise of placental blood flow. We propose that the combined vasoconstrictive effects of MDMA and LSD caused placental ischaemia, contributing to the fetal death and precipitating a cascade of endothelial dysfunction which resulted in an eclamptic syndrome.
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Affiliation(s)
- Katherine Scott
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
| | - Narelle Fagermo
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
| | - Leonie Callaway
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
| | - Karin Lust
- Obstetric Medicine Unit, Royal Brisbane and Women's Hospital , Brisbane, Queensland , Australia
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18
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Abstract
Illicit substance use is not uncommon in women of childbearing age. The direct effects of illicit substance use on the mother, pregnancy and the fetus are not well understood, in contrast to the indirect effects of social disadvantage and intercurrent medical and psychiatric illness, which are well documented. We have undertaken a review of the current literature regarding the effects of illicit substance use in pregnancy and include a suggested approach to identification and management of at-risk women.
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Affiliation(s)
- Katherine Scott
- Department of Internal Medicine and Aged Care, Obstetric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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19
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Zimmermann-Baer U, Nötzli U, Rentsch K, Bucher HU. Finnegan neonatal abstinence scoring system: normal values for first 3 days and weeks 5-6 in non-addicted infants. Addiction 2010; 105:524-8. [PMID: 20402996 DOI: 10.1111/j.1360-0443.2009.02802.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The neonatal abstinence scoring system proposed by Finnegan is used widely in neonatal units to initiate and to guide therapy in babies of opiate-dependent mothers. The purpose of this study was to assess the variability of the scores in newborns and infants not exposed to opiates during the first 3 days of life and during 3 consecutive days in weeks 5 or 6. PATIENTS AND METHODS Healthy neonates born after 34 completed weeks of gestation, whose parents denied opiate consumption and gave informed consent, were included in this observational study. Infants with signs or symptoms of disease or with feeding problems were excluded. A modified scoring system was used every 8 hours during 72 hours by trained nurses; 102 neonates were observed for the first 3 days of life and 26 neonates in weeks 5-6. A meconium sample and a urine sample at weeks 5-6 were stored from all infants to be analysed for drugs when the baby scored high. Given a non-Gaussian distribution the scores were represented as percentiles. RESULTS During the first 3 days of life median scores remained stable at 2 but the variability increased, with the 95th percentile rising from 5.5 on day 1 to 7 on day 2. At weeks 5-6 median values were higher during daytime (50th percentile = 5, 95th percentile = 8) than night-time (50th percentile = 2, 95th percentile = 6, P = 0.02). CONCLUSION Scores increase from days 1-3 to weeks 5-6 and show day-night cycles with 5-6 weeks. Values above 8 can be considered pathological. This data may help to raise suspicion of narcotic withdrawal and to guide therapy.
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Affiliation(s)
- Urs Zimmermann-Baer
- Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Zurich, CH - 8091 Zurich, Switzerland
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20
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État des lieux de la consommation de substances psychoactives par les femmes enceintes. Encephale 2010; 36:33-8. [DOI: 10.1016/j.encep.2008.12.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Accepted: 12/01/2008] [Indexed: 01/18/2023]
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Jutras-Aswad D, DiNieri JA, Harkany T, Hurd YL. Neurobiological consequences of maternal cannabis on human fetal development and its neuropsychiatric outcome. Eur Arch Psychiatry Clin Neurosci 2009; 259:395-412. [PMID: 19568685 DOI: 10.1007/s00406-009-0027-z] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 06/05/2009] [Indexed: 02/03/2023]
Abstract
Despite the high prevalence of marijuana use among pregnant women and adolescents, the impact of cannabis on the developing brain is still not well understood. However, growing evidence supports that the endocannabinoid system plays a major role in CNS patterning in structures relevant for mood, cognition, and reward, such as the mesocorticolimbic system. It is thus clear that exposure to cannabis during early ontogeny is not benign and potential compensatory mechanisms that might be expected to occur during neurodevelopment appear insufficient to eliminate vulnerability to neuropsychiatric disorders in certain individuals. Both human longitudinal cohort studies and animal models strongly emphasize the long-term influence of prenatal cannabinoid exposure on behavior and mental health. This review provides an overview of the endocannabinoid system and examines the neurobiological consequences of cannabis exposure in pregnancy and early life by addressing its impact on the development of neurotransmitters systems relevant to neuropsychiatric disorders and its association with these disorders later in life. It posits that studying in utero cannabis exposure in association with genetic mutations of neural systems that have strong relationships to endocannabinoid function, such as the dopamine, opioid, glutamate, and GABA, might help to identify individuals at risk. Such data could add to existing knowledge to guide public health platform in regard to the use of cannabis and its derivatives during pregnancy.
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Affiliation(s)
- Didier Jutras-Aswad
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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22
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Thevis M, Sauer M, Geyer H, Sigmund G, Mareck U, Schänzer W. Determination of the prevalence of anabolic steroids, stimulants, and selected drugs subject to doping controls among elite sport students using analytical chemistry. J Sports Sci 2009; 26:1059-65. [PMID: 18608840 DOI: 10.1080/02640410801910293] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Drug abuse by adolescents has been investigated in various surveys that reported correlations between age, gender, and activity. However, none of these studies included chemical analyses to help substantiate the statements of participants. In the present study, the urine specimens of 964 students (439 females, 525 males; mean age 22.1 years, s = 1.7), who applied to study sports sciences at university, were assessed for anabolic steroids, stimulants, and selected drugs prohibited in sports. In total, 11.2% of the urine specimens provided contained drugs covered by doping controls. The most frequently detected compound was the major metabolite of tetrahydrocannabinol (9.8%) followed by various stimulants related to amphetamine and cocaine (1.0%). Indications of anabolic steroid use were found in 0.4% of urine samples but originated from contraceptives containing norethisterone. The present study provided unambiguous data on the status quo of drug (ab)use by adolescents hoping for a career related to elite sport or sports sciences. No use of anabolic steroids was detected. However, evidence for stimulants and tetrahydrocannabinol administration was obtained, although not reported by any participant, which highlights the issue of under-reporting in surveys based solely on questionnaires.
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Affiliation(s)
- Mario Thevis
- Centre for Preventive Doping Research, Institute of Biochemistry, German Sport University, Cologne, Germany.
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23
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Abstract
PURPOSE OF REVIEW The present article is an update on the effects of drug abuse on pregnancy outcome. RECENT FINDINGS Substance abuse in pregnancy is on the increase worldwide. Simultaneously, there is great variability in prevalence rates in different countries, regions of countries and in different ethnic groups. In the United States nearly 90% of drug-abusing women are of reproductive age. Substances most commonly abused in pregnancy include cocaine, amphetamines, opioids, marijuana, ethanol, tobacco, caffeine, and toluene-based solvents. Polysubstance abuse is very common. SUMMARY Substance abuse in pregnancy is associated with significant maternal and fetal morbidity. Risk factors suggesting substance abuse in pregnancy include lack of prenatal care, history of premature labor, and cigarette smoking. In the United States the American College of Obstetricians and Gynecologists has made multiple recommendations regarding management of parturients with drug abuse during pregnancy. Women who acknowledge use of illicit substance during pregnancy should be counseled and offered necessary treatment. The American College of Obstetricians and Gynecologists also acknowledged that some states consider intrauterine fetal drug exposure to be a form of child neglect or abuse under the law.
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Lozano J, García-Algar O, Marchei E, Vall O, Monleon T, Giovannandrea RD, Pichini S. Prevalence of gestational exposure to cannabis in a Mediterranean city by meconium analysis. Acta Paediatr 2007; 96:1734-7. [PMID: 17953730 DOI: 10.1111/j.1651-2227.2007.00535.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate the prevalence of in utero exposure to cannabis in a cohort of 974 mother-infants dyads from Barcelona (Spain). METHODS A validated gas chromatographic-mass spectrometric assay was used for meconium analysis. RESULTS Prenatal exposure to cannabis was detected in 5.3% newborns; however, only 1.7% of the participating mothers disclosed gestational drug use. Ethnicity was not associated with cannabis use, nor were the maternal features or newborns somatometry. A significantly higher percentage of cannabis using mothers had a managerial professional job versus nonusers. CONCLUSIONS Meconium analysis is especially important to identify neonates who have been exposed to cannabis in utero, which appear normal at birth and therefore may not be recognized. Timely detection of these newborns at risk provides the basis for appropriate treatment and adequate medical and social follow-up.
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Affiliation(s)
- Jaime Lozano
- Unitat de Recerca Infància i Entorn (URIE), Paediatric Service, Hospital del Mar, and Departament de Pediatria, Ginecologia i Obstetrica, i Medicina Preventiva, Universitat Autònoma, Barcelona, Spain
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25
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:596-605. [DOI: 10.1097/gco.0b013e3282f37e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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