morphine and Substance-Related-Disorders

Illicit drug use during pregnancy is a concern worldwide, with many international studies describing attempted strategies to mitigate this problem. Drug misuse during pregnancy is associated with significant maternal as well as perinatal complications, which include a high incidence of stillbirths, fetal distress, neonatal abstinence syndrome (NAS) and increased neonatal mortality. Unfortunately, the identification of a drug-exposed mother or neonate is challenging. Maternal disclosure of drug use is often inaccurate, principally due to psychosocial factors including behavioral denial or the fear of the consequences resulting from such admissions. Likewise, many infants who have been exposed to drugs in utero may appear normal at birth and initially show no overt manifestations of drug effects. Thus, the identification of the drug-exposed infant requires a high index of clinical suspicion. Conversely, analytical testing is an objective means of determining drug exposure when it may be necessary to document proof of the infant's exposure to illicit drugs. The review will discuss the different matrices that are most commonly used for testing (e.g., maternal urine, neonatal urine, meconium, and umbilical cord), the strengths and limitations for each matrix, which drugs and metabolites are appropriate for testing, the various testing methods, and the advantages and disadvantages of each method.

Topics: Female; Hospitalization; Humans; Illicit Drugs; Infant, Newborn; Meconium; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Most existing evidence about the prevalence of prenatal cannabis use relies on self-reported measures, which is limited by social desirability bias and recall bias. To date, several studies have examined the validity of self-reported measures of prenatal cannabis use, but this evidence has yet to be synthesized. To address this gap, we performed a scoping review to systematically identify and synthesize existing evidence on the validity of self-reported measures of cannabis use among pregnant women.. We searched PubMed, PyschINFO, CINAHL, Cochrane/CENTRAL, and Google Scholar for peer-reviewed studies published in English between January 2010 and June 2021. We included studies that compared self-reported measures of cannabis use to a biochemical measure of cannabis (e.g., urine, hair, meconium) in pregnant women. We excluded studies reporting solely on prenatal cannabis use prevalence as well as those that examined self-reported drug use in which cannabis use was not a distinct category.. We found 12 unique studies (11 primary studies and one systematic review) that examined the validity of self-reported prenatal cannabis use, compared to a biochemical sample. Most studies were conducted in the US and conducted in either a hospital or clinical setting. We found that self-report was more valid in populations with a current or prior history of drug use. Self-report was also more valid when assessed via interviews by research team members than health care provider screenings or self-administered surveys. The most commonly used biochemical measure used was urine drug testing, which was found to have the highest level of concordance with self-report.. This scoping review systematically mapped existing evidence on the validity of self-reported prenatal cannabis use. Although much remains unknown in this area, an important next step is a systematic review that would provide robust evidence on clinical utilization of self-reported use in conjunction with biochemical samples. Further research is needed to examine validity by type of measure and mode of administration. Additionally, future studies could assess factors associated with disclosure of use across different critical maternal health periods beyond pregnancy.

Topics: Cannabis; Female; Humans; Infant, Newborn; Male; Maternal Health; Meconium; Pregnancy; Pregnant Women; Self Report; Substance-Related Disorders

The prevalence of drug use during pregnancy continues to increase despite the associated serious adverse obstetrical outcomes, including increased risk of miscarriage, fetal growth restriction, brain development impairment, neonatal abstinence syndrome, preterm delivery, and stillbirths. Monitoring drug use during pregnancy is crucial to limit prenatal exposure and provide suitable obstetrical health care. The authors reviewed published literature reporting the concentrations of common drugs of abuse and new psychoactive substances (NPS), such as synthetic cathinones and synthetic opioids, NPS, and their metabolites using unconventional matrices to identify drug use during pregnancy and improve data interpretation.. A literature search was performed from 2010 to July 2019 using PubMed, Scopus, Web of Science scientific databases, and reports from international institutions to review recently published articles on heroin, cocaine, amphetamine, methamphetamine, synthetic cathinone, and synthetic opioid monitoring during pregnancy.. Meconium has been tested for decades to document prenatal exposure to drugs, but data regarding drug concentrations in amniotic fluid, the placenta, the umbilical cord, and neonatal hair are still lacking. Data on prenatal exposure to NPS are limited.. Maternal hair testing is the most sensitive alternative matrix for identifying drug use during pregnancy, while drug concentrations in the meconium, placenta, and umbilical cord offer the identification of prenatal drug exposure at birth. Adverse developmental outcomes for the infant make it critical to promptly identify maternal drug use to limit fetal exposure or, if determined at birth, to provide resources to the exposed child and family. Alternative matrices offer choices for monitoring and challenge laboratories to deliver highly sensitive and specific analytical methods for detection.

Topics: Alkaloids; Amphetamines; Analgesics, Opioid; Cocaine; Drug Monitoring; Female; Hair; Heroin; Humans; Meconium; Placenta; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance-Related Disorders; Umbilical Cord

Licit and illicit drug use is a common complication of pregnancy. Accurate information on drug use is difficult to obtain for many reasons as women fear self-disclosure or consenting for drug testing due to stigma, guilt, and fear of social and legal harm. As information about drug use is clinically very important, biochemical testing is an important adjunct to careful maternal history. In addition, research studies depend on accurate measures of exposure when reporting risks of a substance. This paper delineates available matrices for and methods of biochemical drug testing in pregnant women and neonates.

Topics: Alcohol Drinking; Amniotic Fluid; Biomarkers; Female; Fetal Blood; Fetus; Hair; Humans; Infant, Newborn; Maternal Exposure; Maternal-Fetal Exchange; Meconium; Placenta; Placental Circulation; Predictive Value of Tests; Pregnancy; Risk Assessment; Saliva; Smoking; Substance Abuse Detection; Substance-Related Disorders; Sweat; Urinalysis

The basic science and clinical use of morphine and other "opioid" drugs are based almost exclusively on the extracts or analogues of compounds isolated from a single source, the opium poppy (Papaver somniferum). However, it now appears that biological diversity has evolved an alternative source. Specifically, at least two alkaloids isolated from the plant Mitragyna speciosa, mitragynine ((E)-2-[(2S,3S)-3-ethyl-8-methoxy-1,2,3,4,6,7,12,12b-octahydroindolo[3,2-h]quinolizin-2-yl]-3-methoxyprop-2-enoic acid methyl ester; 9-methoxy coryantheidine; MG) and 7-hydroxymitragynine (7-OH-MG), and several synthetic analogues of these natural products display centrally mediated (supraspinal and spinal) antinociceptive (analgesic) activity in various pain models. Several characteristics of these compounds suggest a classic "opioid" mechanism of action: nanomolar affinity for opioid receptors, competitive interaction with the opioid receptor antagonist naloxone, and two-way analgesic cross-tolerance with morphine. However, other characteristics of the compounds suggest novelty, particularly chemical structure and possible greater separation from side effects. We review the chemical and pharmacological properties of these compounds.

Topics: Administration, Oral; Analgesics, Opioid; Animals; Humans; Secologanin Tryptamine Alkaloids; Substance-Related Disorders

As drug abuse in our society escalates, child protection workers face mounting challenges in accurately assessing parental substance abuse in the interest of effective child protection. The impartial evaluation of substance use and abuse is fundamental, requiring objective and sensitive methods. A variety of biological specimens, some applicable to short-term and some to long-term monitoring, have been successful when applied to a child protection and drug abuse monitoring of caregivers. This article explores the complementary features of drug testing in urine, hair, and meconium, among other alternative matrices and discusses the practicality, basic science, and applicability of each to substance abuse monitoring in the context of child protection.. Drug testing, hair, meconium, prenatal, toxicology, urine screen, infant, child, drug.

Topics: Adult; Caregivers; Child; Child of Impaired Parents; Child Welfare; Hair; Humans; Meconium; Social Work; Substance Abuse Detection; Substance-Related Disorders

Despite extensive evidence of fetal and neonatal risk, a large number of pregnant women are involved in excessive alcohol and drug abuse, such as with cocaine, methamphetamine, opioids, and cannabinoids.

Topics: Adolescent; Adult; Alcohol-Related Disorders; Amphetamine-Related Disorders; Biomarkers; Cannabinoids; Child Welfare; Child, Preschool; Cocaine-Related Disorders; Esters; Fatty Acids; Female; Hair; Humans; Infant; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance Abuse Detection; Substance-Related Disorders

Prenatal substance abuse is an ongoing concern with significant impact on neonatal health and development across socioeconomic lines. Meconium, passed by neonates during their first post-natal bowel movements, is a matrix unique to the developing fetus and contains a long history of prenatal metabolism. Over the last two decades, the use of meconium as a matrix for assessing prenatal exposure to drugs of abuse has yielded methods exhibiting higher sensitivity, easier collection, and a larger window of detection than traditional matrices. Recently, a method has been developed for the analysis of fatty acid ethyl esters in meconium as a biomarker of fetal alcohol exposure, potentially facilitating the future diagnosis of Fetal Alcohol Spectrum Disorder in situations where gestational alcohol consumption history is unknown. Screening for prenatal exposure to illicit and abused licit drugs in meconium is possible by use of a variety of immunoassay methods with conformational analysis usually occurring by GCMS or LCMS. In spite of increased sample preparation time relative to blood and urine, the long metabolic history, coupled with the ease and wide window of collection of meconium make it the ideal matrix for determining fetal drug exposure.

Topics: Female; Humans; Immunoassay; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Pregnancy; Reproducibility of Results; Substance Abuse Detection; Substance-Related Disorders

The use of licit and illicit drugs and exposure to other xenobiotic agents during pregnancy is common. These substances are known to have adverse effects on the pregnancy and fetus; however information on fetal exposure is sparse due to the lack of an appropriate measure of exposure. Meconium analysis is a new method for identifying in utero exposure of infants to a number of illicit and legal drugs, alcohol, nicotine, heavy metals, pesticides, congenital infections. It's testing is non-invasive, highly accurate and able to detect prior exposure in utero during 12-40 weeks of gestation. This has implications for toxicology to develop improved methods to identify exposed infants.

Topics: Designer Drugs; Female; Health Education; Humans; Illicit Drugs; Infant, Newborn; Infant, Newborn, Diseases; Maternal Welfare; Meconium; Mothers; Pregnancy; Prenatal Exposure Delayed Effects; Risk Factors; Substance-Related Disorders; Xenobiotics

Several methods of drug testing are efficacious in identifying and monitoring drug use during pregnancy. Urine screening remains the most commonly used method despite the limited period during which drugs can be detected. Hair has been recognized as a possible alternate test specimen, but wider acceptance of hair testing must await better understanding of drug disposition in hair, answers to the issues relating to interpretation, and the development of less demanding laboratory techniques. Regardless of the matrix used, proper interpretation of the results of drug testing requires familiarity with the sensitivity, specificity, and limitations of the laboratory methodologies employed. Moreover, unconfirmed positive results may actually be false-positives and must be interpreted with caution, particularly if they are the basis for major clinical decisions.

Topics: Amniotic Fluid; Female; Hair; Humans; Meconium; Pregnancy; Pregnancy Complications; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders; Urinalysis

Although urine testing remains the standard method for identifying and monitoring drug addicts, recent data suggest that it seriously underdiagnoses the prevalence of fetal exposure to various drugs. Results obtained with other body fluids and tissues (meconium and hair) are reviewed and the laboratory methodologies used to detect drugs are discussed in details.

Topics: Female; Hair; Humans; Interviews as Topic; Mass Screening; Meconium; Pregnancy; Pregnancy Complications; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders

Fetal alcohol syndrome, fetal alcohol effects, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects, all terms referring to the spectrum of consequences of in utero exposure to ethanol, are a major public health burden. There is currently no laboratory test to identify newborns exposed to ethanol in utero. Meconium was analyzed for ethyl linoleate, a metabolite of ethanol, as a biological marker for fetal ethanol exposure.. Samples of meconium were obtained from 248 infants and analyzed for fatty acid ethyl esters. Detailed maternal alcohol, tobacco, and drug use histories were obtained within 1 month of giving birth.. The detection of ethyl linoleate in meconium was called a positive test. The mean number of drinks reported per week in the month before pregnancy, the first trimester, and overall were significantly higher in the positive group (unadjusted: 9.2 +/- 1.9 vs. 4.3 +/- 1.4, p = 0.004; 7.3 +/- 1.7 vs. 3.8 +/- 1.2, p = 0.03; and 6.1 +/- 1.3 vs. 3.0 +/- 1.0, p = 0.006). A positive test was not associated with marijuana, cocaine, or tobacco use. Sensitivity and specificity of the test were 72% and 51% to distinguish women who reported 1 or more drinks/week in the third trimester from women who denied use, and 68% and 48% to distinguish women who used > or =1 drink/week from women who used <1 drink/week in the month before pregnancy.. The presence of ethyl linoleate in meconium is the first reported biological marker for maternal ethanol use during pregnancy. Because of the inherent inaccuracy associated with the use of self-reporting, the establishment of true values of sensitivity and specificity will require validation where the presence, quantity, and timing of exposure to alcohol is known. Further validation of this marker will permit identification and intervention of at-risk infants.

Topics: Adult; Alcohol Drinking; Biomarkers; Chromatography, Gas; Ethanol; Female; Humans; Infant, Newborn; Linoleic Acids; Meconium; Pregnancy; Pregnancy Trimesters; Prenatal Exposure Delayed Effects; Sensitivity and Specificity; Substance-Related Disorders

This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model.. This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed.. Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each. This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative.. · Many common drug screening criteria are not predictive.. · Four criteria predicted positive infant drug tests.. · No infant urine drug test is needed if the mother tests negative..

Topics: Female; Humans; Infant, Newborn; Mass Screening; Meconium; Pregnancy; Retrospective Studies; Substance Abuse Detection; Substance-Related Disorders

In the last decade there has been a dramatic increase in the availability and abuse of synthetic cathinones - new amphetamine-like stimulants. Even though their abuse during pregnancy could have serious adverse effects on the fetus, cathinones are not readily included in neonatal toxicological screenings. Meconium (first neonatal stool) is the specimen of choice to reveal long term drug exposure, however as it is a highly complex matrix, the sample preparation is a critical step before the instrumental analysis. The aim of this work was to develop a suitable meconium sample extraction technique using the advantages of salting-out assisted liquid-liquid extraction (SALLE) and using only MS-friendly organic ammonium salts. We further developed and validated liquid chromatography tandem-mass spectrometry method for the determination of 'traditional' stimulants (methamphetamine, amphetamine, MDMA) and cathinones (mephedrone, methylenedioxypyrovalerone (MDPV), α-pyrrolidinopentiophenone (α-PVP), methylone, butylone, flephedrone, and naphyrone). Matrix-matched calibration was prepared in the concentration range 10-2000 ng/g. The limits of quantification were determined as 10 ng/g, recoveries ranged from 48.2% to 94.3% and the matrix effect was between 60.2% and 101.4%. Accuracy (86.1-114.5%) and precision (4.9-14.9%) were determined and all validation criteria were met for all analytes except for naphyrone. Finally, our analytical method was tested on a set of real meconium samples, which were found positive for amphetamine, methamphetamine and methylone, thus demonstrating the validity of the method.

Topics: Ammonium Compounds; Amphetamines; Central Nervous System Stimulants; Chromatography, High Pressure Liquid; Feasibility Studies; Female; Humans; Infant, Newborn; Limit of Detection; Liquid-Liquid Extraction; Meconium; Pregnancy; Pregnancy Complications; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry

New psychoactive substances have been introduced into the market in the last years due to their unregulated status. Synthetic cathinones are one of their main representatives, and they have shown to produce neonatal complications. It is important to have objective tools to identify in utero exposure to drugs that have shown to produce neonatal complications. An analytical method was developed and fully validated for the determination of common synthetic cathinones, including methylone, methedrone, mephedrone, 3,4-methylenedioxypyrovalerone (MDPV), (±)-4-fluoromethamphetamine and 4-fluoromethcathinone in meconium. Meconium (0.25 ± 0.02 g) was homogenized with methanol by sonication for 30 min. After centrifugation, the sample was extracted with Oasis MCX columns. The analysis was performed by LC-MS/MS using an Atlantis T3 column (3 μm, 2.1 × 50 mm) and a gradient with acetonitrile and 0.1% formic acid in water. Method validation included the following parameters: selectivity (no endogenous or exogenous interferences), limits of detection (n = 3, 0.5-1 ng/g) and quantification (n = 3, 1-2 ng/g), linearity (n = 5, LOQ-200 ng/g), imprecision (n = 15, 0% to 10%), accuracy (n = 15, 87.3% to 97.8%), matrix effect (n = 10, -76% to -28.1%), extraction efficiency (n = 6, 63.7% to 91.3%), total process efficiency (n = 6, 16% to 60.2%) and stability for 72 h in the autosampler (n = 3, %loss = -6.7% to 5.1%). The method was applied to 28 meconium specimens.

Topics: Adult; Alkaloids; Chromatography, High Pressure Liquid; Female; Humans; Meconium; Pregnancy; Substance-Related Disorders; Tandem Mass Spectrometry

Opioid and cocaine antenatal substance use can result in significant obstetric and pediatric health implications. Accurate detection of in utero-exposed neonates can improve patient care and health outcomes. Therefore, the effectiveness of mother-infant biological and diagnostic indicators collected at labor and delivery to provide accurate detection of in utero opiate and cocaine exposure was assessed.. A retrospective medical chart review included 335 mother-infant dyads exposed to antenatal substances who were delivered between January 2009 and March 2014. Mother-infant dyads were a subset of a larger retrospective cohort of 560 substance-using mothers, who had a valid meconium drug screen (MDS) and anesthesia before delivery. Alternative biological and diagnostic indicators of maternal urine drug screens (UDS), maternal substance use International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and neonatal exposure diagnostic ICD-9-CM codes were compared against MDS. Data were analyzed using classification accuracy measures.. Compared with MDS, maternal UDS had the highest sensitivity [0.52, 95% confidence interval (CI), 0.39-0.65] and specificity (0.88, 95% CI, 0.79-0.97) to detect intrauterine opiate exposure. Maternal substance use diagnosis had the highest sensitivity (0.39, 95% CI, 0.16-0.61) and maternal UDS had the highest specificity (1.00, 95% CI, 0.99-1.00) to detect intrauterine cocaine exposure. Cocaine exposure had significantly higher accuracy scores across detection methods compared with opiate exposure.. Alternative indicators collected at delivery were ineffective at identifying in utero substance exposure, especially neonatal-exposed ICD-9-CM codes. Low sensitivity scores indicate that many exposed neonates could be misdiagnosed or left untreated. Accurate antenatal exposure identification at delivery is an important form of tertiary assessment that warrants the development of improved screening methodology and standardization of hospital biological drug testing.

Topics: Biological Assay; Cocaine; Cohort Studies; Female; Humans; Infant; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Narcotics; Opiate Alkaloids; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Retrospective Studies; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders

The objective of this study was to compare detection rates of newborn drug exposure at an academic medical center transitioning from meconium to umbilical cord tissue toxicology testing.. We performed an Institutional Review Board-approved retrospective chart review on all newborns (n=2072) for whom newborn drug testing was ordered at our academic medical center between June 2012 and August 2015 (in August 2013, umbilical cord tissue became the preferred specimen).. Meconium toxicology testing was positive for at least one compound in 221 cases (21.3% of 1037 total specimens), with non-medical drug use identified in 85 cases (8.2%). Umbilical cord tissue toxicology testing was positive for at least one compound in 302 cases (29.2%), with non-medical drug use identified in 107 cases (10.3%). Of the cases involving non-medical drug use, the most common compounds detected were tetrahydrocannabinol and amphetamines. Non-medical drug use did not differ significantly between meconium and umbilical cord tissue, either as a total or for classes of drugs such as amphetamines, cannabinoids, and opiates. Maternal non-medical use of tramadol (not tested for in meconium) was identified in 5 cases (0.4%). There were significant differences in rate of detection of iatrogenic medications. Specifically, morphine, lorazepam, phenobarbital, and codeine were more commonly detected in meconium, while oxycodone was more commonly detected in umbilical cord tissue.. Umbilical cord tissue toxicology testing yielded a similar detection rate compared to meconium testing. The use of umbilical cord tissue avoids detection of medications given to the neonate prior to meconium collection.

Topics: Academic Medical Centers; Dronabinol; Female; Humans; Infant, Newborn; Meconium; Retrospective Studies; Substance Abuse Detection; Substance-Related Disorders; Umbilical Cord

It is now generally recognized that upon activation by an agonist, β-arrestin associates with G protein-coupled receptors and acts as a scaffold in creating a diverse signaling network that could lead to adverse effects. As an approach to reducing side effects associated with κ opioid agonists, a series of β-naltrexamides 3-10 was synthesized in an effort to selectively target putative κ opioid heteromers without recruiting β-arrestin upon activation. The most potent derivative 3 (INTA) strongly activated KOR-DOR and KOR-MOR heteromers in HEK293 cells. In vivo studies revealed 3 to produce potent antinociception, which, when taken together with antagonism data, was consistent with the activation of both heteromers. 3 was devoid of tolerance, dependence, and showed no aversive effect in the conditioned place preference assay. As immunofluorescence studies indicated no recruitment of β-arrestin2 to membranes in coexpressed KOR-DOR cells, this study suggests that targeting of specific putative heteromers has the potential to identify leads for analgesics devoid of adverse effects.

Topics: Analgesics; Animals; Arrestins; Avoidance Learning; beta-Arrestins; Calcium; Drug Tolerance; HEK293 Cells; Humans; Indoles; Mice; Naltrexone; Protein Multimerization; Receptors, Opioid, delta; Receptors, Opioid, kappa; Receptors, Opioid, mu; Stereoisomerism; Structure-Activity Relationship; Substance-Related Disorders

As the patterns and frequency of maternal and clinical conditions and outcomes and gross and histological placental features and lesions vary with gestational age at delivery, we aimed to study the impact of these changes on the placental diagnosis, hoping to uncover potential novel clusters of gestational age-associated clinical and pathological diagnoses.. Retrospective statistical analysis of clinicoplacental database.. We analyzed 28 clinical (maternal and fetal) and 49 gross and microscopic placental variables from 3294 consecutively signed placentas received between 2001 and 2012, divided into three gestational age groups: 16-27 weeks, 697 cases; 28-36 weeks, 1365 cases; and 37+ weeks, in all 1232 cases.. Classical statistics by chi-squared and Fischer's tests, and the Ward agglomerative hierarchical clustering and multidimensional scaling techniques, were used.. The placental phenotypes clustered statistically significantly with severe preeclampsia in the second trimester; preterm premature rupture of membranes, placental abruption, and fetal growth restriction in the whole third trimester; and abnormally invasive placenta, thick meconium, maternal diabetes mellitus, and substance abuse in term pregnancies.. The applied statistical analyses made it possible to simultaneously compare the strength of clinicoplacental associations separately in three pregnancy intervals. Placental clinicopathological associations are strongest for the second trimester, i.e. severe preeclampsia and preterm ascending infection-related conditions, but were not significant for other pregnancy complications such as mild preeclampsia, chronic hypertension, diabetes mellitus, or umbilical cord compromise.

Topics: Abruptio Placentae; Adult; Cluster Analysis; Databases, Factual; Female; Fetal Growth Retardation; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Meconium; Phenotype; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Retrospective Studies; Substance-Related Disorders

The objective of this study was to identify high-yield screening risk factors for detecting maternal non-medical drug use during pregnancy.. A four year retrospective analysis was conducted at an academic medical center. Detailed chart review of both the newborn and mother's medical record was performed on all cases for which one or more drug(s) or metabolite(s) were identified and confirmed in meconium or urine.. 229 (9.2%) of 2,497 meconium samples out of 7,749 live births confirmed positive for one or more non-medical drugs. History of maternal non-medical drug and/or tobacco use in pregnancy was present in 90.8% of non-medical drug use cases. Addition of social risk factors and inadequate prenatal care increased the yield to 96.9%.. Use of focused screening criteria based on specific maternal and social risk factors may detect many prenatal non-medical drug exposures.

Topics: Adolescent; Adult; Amphetamines; Analgesics, Opioid; Benzodiazepines; Cocaine; Dronabinol; Female; Humans; Illicit Drugs; Infant, Newborn; Meconium; Pregnancy; Prenatal Care; Retrospective Studies; Risk Factors; Smoking; Substance Abuse Detection; Substance-Related Disorders; Urinalysis; Young Adult

Detection of prenatal drug abuse exposure is essential to ensure an appropriate monitoring of affected children. A maternal questionnaire is not an efficient screening tool. The usefulness of maternal hair and meconium as biological materials to assess this exposure has been described in last few years. The aim of this study was to compare both these alternative biological materials for prenatal drug exposure detection in the third trimester of pregnancy, in order to assess its use as a screening tool.. Between January and March 2010, samples of maternal hair and meconium from 107 mother-infant dyads were collected in Can Misses Hospital, Ibiza. The presence of opiates, cocaine, cannabis, and amphetamines, was determined in both materials, using standard chromatographic techniques.. Maternal hair analysis showed a 15.9% positivity for drugs of abuse (17 cases): 11 cannabis, 7 cocaine, 1 cannabis and ecstasy, and 1 cannabis and cocaine. Only one mother reported cannabis consumption and another one, cocaine. Of the 7 cocaine positive cases in hair, 6 were confirmed in meconium analysis, while of 11 cannabis positive cases, only 3 were confirmed in meconium. Two different consumer profiles were defined: cocaine consumers and cannabis consumers (with only 2 cases of multiple drug use). The highest level of cocaine ever published was detected (1.582ng/g) in one case.. This study reveals a high prevalence of drug abuse in this cohort during pregnancy. Improved screening methods may optimize prevention and monitoring of exposed infants. Maternal hair seems to be more sensitive than meconium to detect prenatal exposure to cannabis during the third trimester, so it might become a good screening tool.

Topics: Adult; Amphetamines; Analgesics, Opioid; Cannabinoids; Cocaine; Female; Hair; Humans; Illicit Drugs; Meconium; Pregnancy; Pregnancy Trimester, Third; Substance-Related Disorders

Newborns exposed to illicit drugs or alcohol in utero can face physical, social, and emotional obstacles. Outcomes for children with fetal alcohol syndrome disorders are well documented in the literature. Data exist on the effects of maternal illicit drug use. Identifying perinatal substance abuse can increase positive outcomes for newborns and create the opportunity for mothers to access assistance through referrals to community resources.This article provides insight on how hospitals can implement an effective screening tool through patient surveying and testing, nurse education, and collaboration with community agencies in a multidisciplinary advisory committee setting.This discussed method of universal perinatal screening results in increased positive screens and increased referrals for care and support. Emphasis is placed on universal screening and testing methods. Nurses are trained in motivational interview techniques that convey empathy, listening, and objectivity. Community agencies partner with hospital staff through onsite meetings with families that determine the best discharge plan for the newborn. The multidisciplinary advisory committee meets continually to discuss future enhancements.

Topics: Colorado; Community Mental Health Services; Education, Nursing; Female; Hospitals; Humans; Infant, Newborn; Interdisciplinary Communication; Interview, Psychological; Meconium; Perinatal Care; Pregnancy; Substance Abuse Detection; Substance-Related Disorders

This report describes testing of a case of in utero drugs of abuse exposure in which discordant results were seen between urine and meconium, and between twin meconium samples. The discordance between urine and meconium could be explained by the differences in detection window, threshold concentration and screening technology, and the discordance between dizygotic twin meconium samples could be explained by the differences in drug diffusion and placental and fetal biotransformation of drugs. The meconium sample of one twin screened negative for benzodiazepines was reported positive in the confirmation assay with higher sensitivity and a lower cut-off concentration. Negative screening results of drugs of abuse should be interpreted with caution, taking into account matrix type, reactivity of drugs in the assay and cut-off concentration. If screening results are inconsistent with each other or with the clinical scenario, confirmation testing using more sensitive and specific methods with lower cut-offs is warranted.

Topics: Female; Humans; Illicit Drugs; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Pregnancy; Pregnancy Complications; Reproducibility of Results; Substance-Related Disorders; Twins, Dizygotic

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.

Topics: Analgesics, Opioid; Cocaine; Ethanol; Fatty Acids; Female; Fetal Alcohol Spectrum Disorders; Fetus; Hair; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Narcotics; Oxycodone; Population Groups; Pregnancy; Pregnancy Complications; Risk; Substance Abuse Detection; Substance-Related Disorders

We evaluated prenatal substance use in a cohort of 480 HIV-infected women and their uninfected children. Substance use was reported by 29%; the most common substances reported were tobacco (18%), alcohol (10%), and marijuana (7.2%). Fewer than 4% of women reported cocaine or opiate use. Substance use was more common in the first trimester (25%) than the second (17%) and third (15%) (trend p-value <0.01), and was associated with race/ethnicity, education, birthplace, age and marital status. For 264 mother/infant pairs with meconium results, sensitivity of self-report was 86% for tobacco, 80% for marijuana and 67% for cocaine. Higher discordance between self-report and urine/blood toxicology was observed for cocaine, marijuana and opiates in a non-random subset of mothers/infants with these tests. Findings suggest reasonably complete self-reporting of substance use as confirmed by meconium analysis. Illicit substance use was low and substantially less than that reported in earlier studies of HIV-infected women, but alcohol and tobacco exposure was prevalent.

Topics: Adolescent; Adult; Cohort Studies; Female; HIV Infections; Humans; Infant, Newborn; Meconium; Middle Aged; Pregnancy; Pregnancy Complications; Pregnancy Trimesters; Prenatal Exposure Delayed Effects; Prevalence; Self Report; Socioeconomic Factors; Substance Abuse Detection; Substance-Related Disorders; United States; Young Adult

For the first time in Europe, the <> aimed to estimate the prevalence of drug use by pregnant women and the subsequent foetal exposure to illicit drugs.. Between October 2002 and February 2004, 1209 mother-infant dyads from the Hospital del Mar, Barcelona, Spain met eligibility criteria and agreed to participate in the study. Data on socio-economic and demographic characteristics and on drug habits during pregnancy were collected using a structured questionnaire. Neonatal meconium was collected within 24h after birth and analyzed by standardized chromatographic techniques for the presence of opiates, cocaine, cannabinoids and amphetamines.. Meconium analysis showed an overall 10.9% positivity for drugs of abuse, with a specific prevalence of heroin, cocaine and cannabis with foetal exposure of 4.7, 2.6 and 5.3%, respectively. Structured interviews also revealed that 0.3, 1.2 and 1.5% of mothers used heroin, cocaine and cannabis, respectively, while only one mother declared ecstasy consumption, confirmed by meconium analysis. Parental ethnicity and working class was not associated with drug use. Drug consuming mothers were shown to have a higher number of previous abortions when compared to non-consumer mothers, which was probably due to a lack of family planning. Significantly lower birth weight and length was found in newborns from mothers exposed to cocaine alone or in combination with other drugs.. This study, although developed in a low socio-economic-status cohort, may serve as an eye opener for any hidden non-negligible drug consumption during pregnancy. In this sense, meconium analysis can be important to identify neonates with a high suspicion of exposure to drugs of abuse in utero, and provides the basis for appropriate treatment and adequate medical and social follow-up.

Topics: Female; Fetus; Humans; Meconium; Pregnancy; Prevalence; Socioeconomic Factors; Spain; Substance-Related Disorders

A method for the simultaneous quantification of 20 cocaine, amphetamine, opiate, and nicotine analytes in meconium, the first neonatal feces, by liquid chromatography tandem mass spectrometry was developed and validated. Specimen preparation included methanol homogenization and solid phase extraction. Two injections were required to achieve sufficient sensitivity and linear dynamic range. Linearity ranged from 0.5-25 up to 500 ng/g (250 ng/g p-hydroxymethamphetamine), and correlation coefficients were >0.996. Imprecision was <10.0% CV, analytical recovery 85.5-123.1%, and extraction efficiencies >46.7% at three concentrations across the linear range. Despite significant matrix effects of -305.7-40.7%, effects were similar for native and deuterated analytes. No carryover, endogenous or exogenous interferences were observed, with analyte stability at room temperature, 4 degrees C, and -20 degrees C and on the autosampler >70%, except for 6-acetylmorphine, hydrocodone, oxycodone, and morphine. Method applicability was demonstrated by analyzing meconium from drug-exposed neonates.

Topics: Amphetamine; Chromatography, Liquid; Cocaine; Feces; Humans; Infant, Newborn; Meconium; Narcotics; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry

The results of meconium specimens and fortified samples screened for drugs of abuse by both enzyme multiplied immunoassay technique (EMIT((R) )II) and enzyme-linked immunosorbent assay (ELISA) methods were compared. The sample preparation for the ELISA screen was a simple buffer extraction versus a lengthy and more laborious sample preparation procedure for the EMIT II screen. The ELISA method was automated using a TECAN Genesis. The EMIT II analysis was automated with an Olympus AU400e. The opioid screen was calibrated with hydromorphone and the benzodiazepine screen was calibrated with clonazepam to maximize detection for these analytes. Previously validated gas chromatography-mass spectrometry (GC-MS), two-dimensional GC-MS, or liquid chromatography-tandem MS methods were used for confirmation. Results from the two techniques compared well. Agreement of the ELISA assay was greater than 90% when compared to EMIT II for all drug classes except barbiturates and benzodiazepines. ELISA appears to be more sensitive than EMIT II for the detection of amphetamines, methadone, propoxyphene, and cocaine. ELISA compared well to EMIT II for cannabinoids, opioids, and PCP. Specificity of the ELISA assay was slightly better for PCP and opioids. EMIT II appears to be more sensitive for the detection of barbiturates and benzodiazepines. The ELISA method reduced turnaround time by 50% compared to the EMIT II method.

Topics: Amphetamines; Analgesics, Opioid; Barbiturates; Benzodiazepines; Cannabinoids; Chromatography, Liquid; Cocaine; Dextropropoxyphene; Enzyme Multiplied Immunoassay Technique; Enzyme-Linked Immunosorbent Assay; False Positive Reactions; Female; Fetus; Gas Chromatography-Mass Spectrometry; Humans; Illicit Drugs; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Methadone; Phencyclidine Abuse; Pregnancy; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders; Tandem Mass Spectrometry

Two versions of enzyme-linked immunosorbent assay (ELISA) kits designed for the detection of benzodiazepine drugs and metabolites (Immunalysis) were evaluated for use with meconium specimens. One was an older kit, and one was a new replacement kit developed for better detection of several commonly prescribed benzodiazepines and metabolites. The kits were evaluated by analyzing 68 patient specimens previously analyzed by liquid chromatography-tandem mass spectrometry and eight quality control samples. In addition to the recommended calibrator (oxazepam), clonazepam was evaluated as an alternate calibrator for the new kit. Detection and sensitivity for some analytes was improved using the new ELISA kit, but was reduced for others. The new kit using clonazepam as the calibrator provided the most sensitive assay for detection of the 11 benzodiazepines and metabolites reported here.

Topics: Benzodiazepines; Calibration; Clonazepam; Enzyme-Linked Immunosorbent Assay; Female; Humans; Hypnotics and Sedatives; Infant, Newborn; Meconium; Oxazepam; Pregnancy; Reference Standards; Reproducibility of Results; Substance Abuse Detection; Substance-Related Disorders

In this issue, Gideon Koren and colleagues review the maternal and child health implications of drug-residue testing in maternal and neonatal hair and testing for drugs in meconium. Since the 1990s, these methods have been used to varying degrees in clinical practice, but recent technological advances have increased their accuracy and usability in the clinical setting. Compared with self-reported maternal use, drug-residue testing in hair and testing for drugs in meconium are more reliable methods for detecting drug and alcohol exposure during pregnancy. These methods can also provide insights into patterns of use and abuse of these substances.

Topics: Adolescent; Adult; Biomarkers; Female; Hair; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Substance Abuse Detection; Substance-Related Disorders

We assessed the agreement of testing for fetal exposure to illicit drugs contrasting paired specimens of meconium vs umbilical cord tissue.. We obtained paired samples of meconium and umbilical cord tissue from 118 pregnancies with high suspicion of illicit drug use by the mothers. Each specimen was tested for amphetamines, opiates, cocaine, cannabinoids, and phencyclidine using drug class-specific immunoassays.. The agreement of drug screening results between cord and meconium was above 90% for all drugs tested. Meconium identified 21 cases as positive for amphetamines. The paired cord identified 20 of these, and in addition identified three other positives that the meconium labeled as negative. Gas chromatography-mass spectrometry confirmed these three cord samples as methamphetamine positive. Meconium identified 97 samples that were negative for amphetamines, while the cord identified 94 of these as negative but three as positive. Agreement of cord with meconium for amphetamines was 96.6%. The concordance for opiates was 94.9%, for cocaine was 99.2%, and for cannabinoids was 90.7%.. Umbilical cord tissue performs as well as meconium in assessing fetal drug exposure to amphetamines, opiates, cocaine, and cannabinoids. Results of studies using the cord may have a more rapid return to the clinician, because waiting for meconium to be passed sometimes requires several days. Moreover, in some cases the meconium is passed in utero making collection impossible, whereas cord should always be available for drug testing.

Topics: Amphetamines; Cannabinoids; Cocaine; Female; Fetus; Humans; Meconium; Narcotics; Phencyclidine; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Reproducibility of Results; ROC Curve; Substance Abuse Detection; Substance-Related Disorders; Umbilical Cord

In a pilot study to determine the local prevalence of maternal drug misuse, meconium from 400 infants was analysed for metabolites of eight controlled drugs. Cannabinoids were found in 13.25%, cocaine in 2.75%, and amphetamine in 1.75%. The prevalence of opiate and benzodiazepine misuse was masked by the presence of prescribed drugs so was undeterminable.

Topics: Cannabinoids; Female; Gas Chromatography-Mass Spectrometry; Humans; Infant, Newborn; Marijuana Abuse; Maternal-Fetal Exchange; Meconium; Pilot Projects; Pregnancy; Pregnancy Complications; Prevalence; Scotland; Substance-Related Disorders

For the first time in Europe, the "Meconium Project" aimed to estimate the prevalence of drug use by pregnant women and the effects of exposure to illicit drugs during pregnancy on the fetus and infant. Between October 2002 and February 2004, 1151 (79%) dyads among the 1439 mother-infant dyads from the Hospital del Mar, Barcelona, Spain, met eligibility criteria and agreed to participate in the study. We present preliminary results on the first 830 meconium samples and 549 mother-infant dyads, for which statistical analysis of socio-economic and demographic characteristics and newborn somatometry was completed. The meconium analysis showed an overall 7.9% positivity for drugs of abuse, with 6-monoacetylmorphine and cocaine being the analytes, most frequently found in samples positive for opiates and cocaine. Structured interview disclosed 1.3, 1.8 and 1.3% of mothers exposed to opiates, cocaine and both drugs, while only one mother declared ecstasy consumption. Meconium analysis showed that prevalence of opiates, cocaine and combined drugs exposure was 8.7, 4.4 and 2.2%, respectively, and confirmed the case of ecstasy use. Arecoline, the main areca nut alkaloid, was found in meconium specimens from four Asiatic newborns, whose mothers declared beetle nut consumption during pregnancy. Parental ethnicity was not associated with drug use, nor was the social class, although a higher tendency toward drug consumption was observed in professional and partly skilled mothers. Drug consuming mothers showed a higher number of previous pregnancies and abortions (p<0.05) when compared to non-consumer mothers (meconium negative test), probably due to a lack of family planning. Consumption of opiates and cocaine during pregnancy was associated with active tobacco smoking, a higher number of smoked cigarettes and cannabis use. Exposure status and smoking behavior correlated with significantly lower birth weight in newborns from mothers exposed only to cocaine and to opiates and cocaine simultaneously. Of the four newborns exposed to arecoline, one showed a low birth weight, low intrauterine growth, hyporeflexia and hypotonia.

Topics: Abortion, Induced; Adult; Arecoline; Body Height; Cholinergic Agonists; Cocaine; Dopamine Uptake Inhibitors; Female; Forensic Medicine; Gravidity; Hallucinogens; Humans; Infant, Low Birth Weight; Infant, Newborn; Italy; Marijuana Smoking; Maternal-Fetal Exchange; Meconium; N-Methyl-3,4-methylenedioxyamphetamine; Narcotics; Pregnancy; Smoking; Spain; Substance Abuse Detection; Substance-Related Disorders

To estimate the current prevalence of prenatal exposure to methamphetamines and other drugs of abuse among infants born in Utah and compare the results with those of a maternal substance abuse prevalence study performed in 1991 in the same geographic area.. Thirteen well baby nurseries in calendar year 2000 and six neonatal intensive care units (NICUs) in 2001-2002 collected anonymous meconium samples and associated, but nonidentifiable, demographic data on consecutively born infants. Samples were screened by enzyme immunoassay and confirmed by gas chromotography/mass spectroscopy for methamphetamines, cannabinoids, and benzoylecognine.. Meconium samples were collected from 1202 well baby nursery infants and 317 NICU infants. There were no significant differences in the rates of positivity for methamphetamines (0.6% versus 0.4%) or marijuana (2.9% versus 1.8%) between the 1991 and 2000/2001 studies. Cocaine prevalence declined from 1.1% in 1991 to 0.3% in 2000/2001 (P =.04). The prevalence of positivity for any of these three drugs declined over the 10-year period from 4.4% to 2.4% (P =.02). The prevalence for positivity for any of these three drugs was higher in the NICUs (4.7%) than in the well baby nurseries (1.9%, P =.008).. The rate of drug-positive infants declined during the decade of the 1990s in a geographic area that is experiencing a sharp rise in the use of methamphetamine among women of childbearing age. Further studies that focus on women of childbearing age who use methamphetamine may help determine factors that impact their drug use during pregnancy and after the infant is born.

Topics: Cohort Studies; Female; Humans; Illicit Drugs; Infant, Newborn; Intensive Care Units, Neonatal; Logistic Models; Maternal Exposure; Meconium; Multivariate Analysis; Patient Education as Topic; Pregnancy; Prenatal Care; Prevalence; Probability; Risk Assessment; Substance Abuse Detection; Substance-Related Disorders; Utah

The objective of this study was to describe drug use by pregnant women participating in the 4-site Maternal Lifestyle Study of in utero cocaine and/or opiate exposure.. Meconium specimens of 8527 newborns were analyzed by immunoassay with GC/MS confirmation for metabolites of cocaine, opiates, cannabinoids, amphetamines, and phencyclidine. Maternal self-report of drug use was determined by hospital interview.. The prevalence of cocaine/opiate exposure in the 4 sites was 10.7% with the majority (9.5%) exposed to cocaine based on the combination of meconium analysis and maternal self-report. However, exposure status varied by site and was higher in low birth weight infants (18.6% for very low birth weight and 21.1% for low birth weight). Gas chromatography/mass spectrometry (GC/MS) confirmation of presumptive positive cocaine screens was 75.5%. In the cocaine/opiate-exposed group, 38% were cases in which the mother denied use but the meconium was positive. There was 66% agreement between positive meconium results and positive maternal report. Only 2% of mothers reported that they used only cocaine during pregnancy and mothers were 49 times more likely to use another drug if they used cocaine.. Accurate identification of prenatal drug exposure is improved with GC/MS confirmation and when the meconium assay is coupled with a maternal hospital interview. However, the use of GC/MS may have different implications for research than for public policy. We caution against the use of quantitative analysis of drugs in meconium to estimate the degree of exposure. Our study also highlights the polydrug nature of what used to be thought of as a cocaine problem.

Topics: Adolescent; Adult; Amphetamines; Birth Weight; Cannabinoids; Cocaine; Female; Gas Chromatography-Mass Spectrometry; Humans; Infant, Newborn; Life Style; Longitudinal Studies; Meconium; Narcotics; Phencyclidine; Pregnancy; Pregnancy Complications; Substance-Related Disorders

To compare the sensitivity and specificity of maternal interview, maternal hair analysis, and meconium analysis in detecting perinatal exposure to cocaine, opiate, and cannabinoid.. The use of cocaine, opiate, and cannabinoid during pregnancy was determined prospectively in 58 women by 3 methods: structured maternal interview, maternal hair analysis, and meconium analyses. The results of the 3 methods were compared with one another.. The maternal interview showed the lowest sensitivity in detecting cocaine and opiate exposures (65% and 67%, respectively), but it had the highest sensitivity in detecting cannabinoid exposure (58%). Both hair and meconium analyses had high sensitivity for detecting cocaine or opiate exposures. Hair analysis had a sensitivity of 100% for cocaine and 80% for opiate detection. However, it had a false-positive rate of 13% for cocaine and 20% for opiate, probably as a result of passive exposure. Meconium analysis had a sensitivity of 87% for cocaine and 77% for opiate detection, but unlike hair analysis, it had no false-positive test results for cocaine. Both hair and meconium analyses had low sensitivity in detecting cannabinoid exposure (21%-22.7%), most probably because of the sporadic use of cannabinoid.. Meconium and hair analyses had the highest sensitivities for detecting perinatal use of cocaine and opiate, but not for cannabinoid. The principal drawback of hair analysis is its potential for false-positive test results associated with passive exposure to drugs. Maternal interview is a time-consuming test of low sensitivity. The high sensitivity of meconium analysis and the ease of collection make this test ideal for perinatal drug screening.

Topics: Adult; Cocaine-Related Disorders; Female; Hair; Humans; Infant, Newborn; Interviews as Topic; Marijuana Abuse; Meconium; Opioid-Related Disorders; Pregnancy; Pregnancy Complications; Prospective Studies; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders

Topics: Animals; Aorta, Thoracic; Cocaine; Cyclic AMP; Electric Stimulation; Guinea Pigs; Humans; Ileum; In Vitro Techniques; Male; Mice; Muscle, Smooth; Opioid-Related Disorders; Rats; Receptors, Dopamine; Receptors, Opioid; Receptors, Serotonin; Substance-Related Disorders

Topics: Amniotic Fluid; Case-Control Studies; Cocaine; Female; Gastric Juice; Humans; Infant, Newborn; Meconium; Neonatal Screening; Pregnancy; Pregnancy Complications; Substance Abuse Detection; Substance-Related Disorders; Urinalysis

Urinary detection of prenatal drug exposure in the neonate may give false-negative results. We report our experience on meconium and hair testing, in addition to urine testing in order to improve diagnosis of fetal drug exposure.. Thirty-one infants (aged 1-45 days) whose mothers were confirmed (n = 12) or suspected (n = 19) to be drug-addicted were included in the study. One or more specimens of urine, meconium or hair were collected in the 31 infants, two of the specimens in 17 and three in six. Drugs and their metabolites were detected by immunoenzymologic techniques and positive results were confirmed by gas-exchange chromatography. All the mothers and families were interviewed during admission and the information was compared to those provided by medical and social services; the results of laboratory analysis were not known by the investigators at this time of the study.. The maternal drug addiction was confirmed after clinical investigation in 18 cases including the 12 cases detected by prenatal interview (group 1), and recused in 13 other cases (group 2). In group 1, nine infants of 12 had a positive urine test (seven opiate, one cocaine, one cannabis), 11 of 11 a positive meconium test (nine opiate, one cocaine, one cannabis), ten of 19 a positive hair test (eight opiate, one cocaine, one cannabis); all infants in this group had at least one positive result. In group 2, all tests were negative except one urine test positive for opiate after cesarean delivery performed under anesthesia including opiate analgesia.. Urine, meconium and hair testing versus urine testing alone increase the sensitivity of laboratory analysis for detection of prenatal drug exposure.

Topics: Cannabis; Cocaine; Female; Hair; Humans; Infant; Infant, Newborn; Male; Maternal-Fetal Exchange; Meconium; Narcotics; Neonatal Abstinence Syndrome; Pregnancy; Pregnancy Complications; Substance-Related Disorders

Topics: Female; Humans; Illicit Drugs; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Pregnancy; Substance-Related Disorders

The aim of this study was to evaluate the hypothesis that prenatal cocaine exposure would negatively affect newborn behavior.. A prospective observational study of term infants recruited from the low-risk nursery used a structured, standardized interview to obtain maternal data. Cocaine exposure was determined by radioimmunoassay of the infant's meconium stool. An examiner blinded to the infant's cocaine status administered the Brazelton Neonatal Behavioral Assessment Scales.. The sample was composed of 23 exposed and 29 nonexposed infants. On six of the seven Brazelton Neonatal Behavioral Assessment Scale clusters, cocaine-exposed infants performed less well than control infants, with significant differences observed for autonomic stability. In addition, a dose-response relationship was suggested. Significant negative, within-group relationships were evident in the exposed group, indicating poorer performance with increasing meconium cocaine concentration for orientation (r = -.40) and regulation of state (r = -.40). Regression model testing of the influence of meconium cocaine concentration on neurobehavioral outcomes, after controlling for significant confounders, identified a significant independent, negative effect of meconium cocaine concentration on two clusters-motor and regulation of state.. In otherwise healthy full-term infants, prenatal cocaine exposure identified by quantitative analysis of cocaine concentration in meconium had a significant, independent negative association with motor and regulation of state that remained after controlling for other significant confounders. A dose-response relationship was evident.

Topics: Adult; Cocaine; Dose-Response Relationship, Drug; Female; Humans; Infant Behavior; Infant, Newborn; Interviews as Topic; Male; Meconium; Pregnancy; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Regression Analysis; Substance-Related Disorders; Urban Population

The analysis of meconium for cocaine and metabolites has proved to be a reliable method for the detection of fetal cocaine exposure. Better sensitivity and a larger gestational window of detection have been demonstrated for meconium testing as compared with neonatal urine testing. Cocaine and cocaine metabolites, including benzoylecgonine, ecgonine methyl ester, cocaethylene, norcocaine, benzoylnorecgonine, and m-hydroxybenzoylecgonine, have been identified in meconium. The origin of these metabolites, whether maternal or fetal, has not been established. This study was conducted to compare the disposition of cocaine and metabolites in meconium from fetuses exposed to cocaine with that of urine from cocaine abusers. Meconium specimens were obtained from six neonates of mothers positive for cocaine use by urinalysis or self-reporting or both during pregnancy. Urine specimens were obtained from 17 adult female and 17 adult male cocaine users enrolled in a treatment program. Specimens were analyzed by gas chromatography-mass spectrometry for cocaine and 12 related analytes. The following analytes were identified and measured in meconium and urine: anhydroecgonine methyl ester; ecgonine methyl ester; ecgonine ethyl ester; cocaine; cocaethylene; benzoylecgonine; norcocaine; norcocaethylene; benzoylnorecgonine; m-and p-hydroxycocaine; and m-and p-hydroxybenzoylecgonine. In addition, both m-and p-hydroxybenzoylecgonine were found to exhibit approximately equal cross-reactivity with benzoylecgonine in the EMIT and TDx assays. The presence of p-hydroxybenzoylecgonine in meconium suggested that this newly identified metabolite, like m-hydroxybenzoylecgonine, might serve as a valuable marker of fetal cocaine exposure during pregnancy. The presence of cocaine and anhydroecgonine methyl ester in meconium was attributed to transfer across the placenta from the mother. However, the origin of the hydrolytic and oxidative metabolites of cocaine could not be established because they were also identified in urine specimens of adult female cocaine users and could have arisen in meconium from either fetal or maternal metabolism.

Topics: Adult; Cocaine; Cross Reactions; Female; Gas Chromatography-Mass Spectrometry; Humans; Infant, Newborn; Male; Meconium; Middle Aged; Pregnancy; Prenatal Exposure Delayed Effects; Reference Standards; Substance-Related Disorders

Topics: Female; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Puerperal Disorders; Substance-Related Disorders

To determine the value of intensive surveillance for cocaine use in pregnancy and also determine the prevalence of cocaine use in our institution.. Among 124 consecutive new obstetrical clinic patients, urine specimens were collected anonymously at the first prenatal visit, in each subsequent trimester of pregnancy, and on labor and delivery. Corresponding newborn urine and meconium were also collected for these patients. 324 urine specimens and 49 meconium specimens were obtained. A local private group also collected first prenatal visit urine from an additional 104 patients. Urine specimens were analyzed for cocaine metabolites by fluorescent polarization immunoassay with confirmation of positive results by gas chromatography/mass spectrophotometry.. One clinic patient had a positive cocaine screen. All other urine and meconium screens were negative.. Intensive surveillance did not increase the detection rate for cocaine abuse in our obstetric population. We also found that the prevalence of cocaine abuse among obstetrical patients at our institution is low (< 1%). These data reconfirm that resource allocation for drug treatment centers should be based on prevalence data specific to an area or institution.

Topics: Cocaine; Female; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Pregnancy; Prospective Studies; Substance Abuse Detection; Substance-Related Disorders

When blood or urine is unavailable, postmortem meconium or stool from infants or stillbirths can be used to detect drugs-of-abuse, thus providing datum in assessing drug-abuse exposure. Two case reports illustrate how drugs-of-abuse findings in post-mortem specimens were used to substantiate exposure prior to death or a history of maternal drug abuse. The first, a congenital hydrocephalus, born to a non-drug abusing mother, expired at the age of 41 days, had opiates in the stool by screening method, enzyme multiplied immunoassay technique, confirmed by gas chromatographic/mass spectrometric (GC/MS) analysis. Investigation revealed that morphine had been administered for three days prior to death. The second was a stillbirth infant born to a drug abuser. Almost equal amounts of benzoylecgonine were found in different bowel segments, a finding consistent with admitted cocaine use throughout pregnancy.

Topics: Adult; Cocaine; Feces; Female; Fetal Death; Humans; Hydrocephalus; Infant; Infant, Newborn; Male; Meconium; Morphine; Pregnancy; Substance-Related Disorders

To determine the prevalence of maternal drug usage in a mid-size midwestern city (population 250,000), we analyzed 1,175 consecutive meconium samples from the neonatal intensive care unit from March 1991 through December 1993. We focused on meconium assays from multiple births as a quality control method. Meconium specimens were analyzed using fluorescence polarization immunoassay (FPIA-Abbott Diagnostics) with confirmation done by gas chromatography/mass spectrometry (GC/MS). Cutoff concentrations of 5 ng/g were utilized for all analytes. A total of 151 samples (12.9%) tested positive. Cocaine-exposed neonates had the highest positive rate (63 or 5.4%), followed by marijuana (52 cases or 4.4%), cocaethylene (12 cases or 1%), and amphetamine (1 case or 0.1%). Nine patients (0.8%) had multiple drugs present. There were a total of 23 sets of multiple births (21 twins, 2 triplets); 20 sets of multiple births (42 patients) had concordance with all births testing negative. Three sets of twins had concordance in testing positive, with 1 twin testing positive for cocaine while the other twin tested positive for cocaine and marijuana. No absolute discordance of twins assays were noted. The rate of maternal drug use through measurement of meconium is about 12.95% in this mid-sized midwestern city. Twin studies provide an excellent method for verifying fetal drug exposure. The use of sets of multiple births provides a unique internal quality control mechanism in determining fetal drug exposure.

Topics: Female; Fluorescence Polarization; Gas Chromatography-Mass Spectrometry; Humans; Illicit Drugs; Illinois; Infant, Newborn; Intensive Care Units, Neonatal; Longitudinal Studies; Meconium; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Prenatal Exposure Delayed Effects; Prevalence; Quality Control; Substance-Related Disorders; Triplets; Twins; Urban Population

Topics: Amphetamine; Chromatography, High Pressure Liquid; Female; Fluorescence Polarization Immunoassay; Humans; Infant, Newborn; Meconium; Morphine; Pregnancy; Pregnancy Complications; Substance-Related Disorders

This study evaluated the neonatal outcome of infants with evidence of fetal exposure to cocaine, opiates, and cannabinoids. Subjects were from the newborn nursery of an inner-city university teaching hospital. Meconium from 141 infants admitted to the full-term nursery was analyzed for metabolites of opiates, cocaine, and cannabinoids. The population was 72% African-American; 82% had medical assistance; history of drug use was reported in the medical records in 18%; mean maternal age was 24.2 years; mean birth weight was 3,234 +/- 502 g; and neonatal abstinence syndrome was reported in 7%. Meconium analysis data showed the following: 52.5% were drug-free; cocaine was present in 31%, opiates in 18% (cocaine and/or opiates 39%), and cannabinoids in 17%. In 38 infants in whom urine toxicology was obtained for clinical indications, meconium was more sensitive than urine in detecting drug exposure (55.3% vs 31.5%). There was no significant difference between cocaine/opiate-exposed and drug-free infants in race, socioeconomic status, maternal age, birth weight, head circumference, length, and Apgar scores. Cocaine/opiate-exposed infants had greater length of stay and increased frequency of maternal sexually transmitted diseases during pregnancy, with a trend toward a higher percent with fetal distress.

Topics: Cannabinoids; Cocaine; Female; Humans; Infant, Newborn; Meconium; Narcotics; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Exposure Delayed Effects; Substance-Related Disorders

We screened anonymously all mothers and infants born during a 3 1/2-month period to determine the prevalence of intrapartum cocaine use, test the maternal characteristics that are specific predictors of intrauterine cocaine exposure (IUCE), and compare the sensitivity of infant urine versus meconium samples for identification of IUCE. Of 1237 live births during the study period, a sample was obtained from 1201 mother-infant pairs. The overall prevalence of documented intrapartum cocaine exposure was 66 (5.5%) of 1201 pairs. Previously developed drug screening guidelines had a sensitivity of 89% for detecting IUCE in infants. Direct comparisons of samples from the same mother-infant pair revealed that there were no cases in which cocaine was found in infant urine but not in meconium; however, infant urine testing missed 25% of the infants who had positive findings in meconium. We conclude that (1) meconium testing was more likely than urine testing to identify an infant with IUCE, detecting an additional 33%; (2) there was significant maternal cocaine use (5.5%) in a teaching hospital with a mixed patient population; (3) maternal characteristics known to identify infants at risk of having IUCE were useful in our population; and (4) IUCE of neonates admitted to the neonatal intensive care unit was more common than that of infants admitted to the regular newborn nursery.

Topics: Cannabis; Cocaine; Female; Forecasting; Gestational Age; Humans; Income; Infant, Newborn; Insurance, Health; Maternal Age; Maternal-Fetal Exchange; Meconium; Pregnancy; Pregnancy Complications; Prevalence; Prospective Studies; Risk Factors; Sensitivity and Specificity; Substance-Related Disorders

To determine the rates of maternal ingestion of cocaine, marijuana, and opiates in women from Minneapolis-St Paul, Minn, in 1993 and compare them with rates observed in 1989; and to compare outcomes of newborns born to those women with and without evidence of prenatal drug ingestion.. The meconium from newborns of a representative cluster-based sample of women from Minneapolis-St Paul was analyzed for metabolites of cocaine, marijuana, and opiates. The newborns were consecutive births in four urban and suburban hospitals. Maternal demographic information and newborn outcome data were collected and matched to the meconium samples. The race, age, and socioeconomic status of the mothers whose newborns were screened were the same as the demographic characteristics of all women delivering babies in Minneapolis-St Paul in 1990 and 1991.. Metropolitan hospitals of Minneapolis-St Paul.. Of the 1333 samples, 27 (2.0%) were cocaine positive, 35 (2.6%) were tetrahydrocannabinol positive, and 16 (1.2%) were opiate positive. There were 168 women (22.6%) reporting that they smoked. Detection of tetrahydrocannabinol and cocaine was more common in newborns of women of color, those receiving medical assistance, and those over age 23 years. Newborns with meconium samples positive for cocaine or tetrahydrocannabinol had slightly lower average birth weights but were no more likely to be premature or to require neonatal intensive care unit admission than newborns with no drugs detected in their meconium. Newborns of mothers who smoked throughout pregnancy had lower average birth weights and higher rates of prematurity and neonatal intensive care unit admissions. Standardized rates of cocaine detection in the four hospitals decreased from 4.0% in 1989 to 2.0% in 1993.. Rates of perinatal cocaine detection have declined in the Twin Cities of Minneapolis-St Paul over the past 4 years. In this population, self-reported smoking was associated with more serious adverse outcomes of the newborns than was the detection of cocaine, marijuana, or opiates.

Topics: Adolescent; Adult; Birth Weight; Cocaine; Dronabinol; Female; Health Promotion; Humans; Infant, Newborn; Infant, Premature; Meconium; Minnesota; Narcotics; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Smoking; Socioeconomic Factors; Substance Abuse Detection; Substance-Related Disorders

A large scale drug screening study was done to determine the prevalence of drug use in a large metropolitan, obstetric population. Meconium and first voided urine, as well as maternal urine were collected from 423 consecutive deliveries. Urine samples and methanolic extracts of meconium were initially screened by Enzyme Multiplied Immunoassay Technique (EMIT) and then confirmed by Gas Chromatography/Mass Spectrometry (GC/MS). Analysis of cocaine metabolite as benzoylecogonine, cannabinoid as carboxy-THC, codeine, morphine and methadone were included in the study. The positive rate for benzoylecgonine was virtually identical for meconium, maternal urine and neonatal urine (12%). Analysis of meconium was found to be more reliable than analysis of maternal or neonatal urine for the detection of benzoylecgonine. Meconium did not appear to offer an advantage over maternal or neonatal urine for detection of cannabinoid, codeine, morphine, or methadone.

Topics: Adult; Cocaine; Dronabinol; Female; Gas Chromatography-Mass Spectrometry; Humans; Illicit Drugs; Immunoassay; Infant, Newborn; Meconium; Methadone; Narcotics; New York City; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Reproducibility of Results; Substance Abuse Detection; Substance-Related Disorders

Postmortem analysis of meconium from three human fetuses exposed to cocaine demonstrated the presence of cocaine in the meconium of a 17-week-old fetus and evidence that the concentration of cocaine in meconium is related to the amount and time of cocaine use by the mother during pregnancy. The latter observation was confirmed in a rat model.

Topics: Animals; Cocaine; Female; Fetal Death; Fetus; Humans; Maternal-Fetal Exchange; Meconium; Pregnancy; Pregnancy Complications; Rats; Rats, Wistar; Substance-Related Disorders

For purposes of mass drug screening, the procedure for analysis of meconium for drugs was modified into a one-step extraction and analysis by enzyme immunoassay. The accuracy of this modified method was tested by comparing the results of simultaneous analysis of 61 meconium samples for cocaine opiate and cannabinoid metabolites by both the original and the modified methods. In 61 samples analyzed, opiate was detected in 8 (13%) samples by the original method and in 9 (15%) by the modified method; cocaine was detected in 39 (64%) samples by the original method and in 39 (64%) by the modified method. The concordance between the negative and positive results of the modified versus the original methods was 98% and 100%, respectively, for opiate and 95% and 98%, respectively, for cocaine. Only one sample was positive for cannabinoid. Thus a comparison of positive results for cannabinoid was not done; however, all the negative results obtained by the modified method were confirmed by the original method. The clinical experience of mass meconium drug testing using the modified method in 1991 is also reported. In four centers tested (total tests = 4409), the prevalence of presence of drug was consistent with the high- or low-risk status of the population. This simplified, rapid procedure can be performed in most clinical laboratories. This adaptation has made the meconium drug test feasible for large-scale clinical and research use.

Topics: Cannabinoids; Cocaine; Female; Humans; Infant, Newborn; Meconium; Morphine; Narcotics; Neonatal Abstinence Syndrome; Neonatal Screening; Pregnancy; Pregnancy Complications; Substance-Related Disorders

A method for simultaneous extraction of cocaine and metabolites benzoylnorecgonine, benzoylecgonine and norcocaine from meconium was developed. The procedure uses solid-phase extraction columns with both cation-exchange and hydrophobic properties after vortex-mixing meconium with methanol. Chromatography utilizes reversed-phase high-performance liquid chromatography with a C18 column and phosphate buffer-acetonitrile as mobile phase. The method is specific and sensitive to 50 ng/g meconium for all compounds. Standard curves are linear from 0.05 to 5.0 micrograms/g (r2 > or = 0.989). Intra-assay coefficients of variation were < or = 6.9%. Meconium from infants exposed to cocaine in utero contained varying combinations of the four drugs.

Topics: Chromatography, High Pressure Liquid; Cocaine; Female; Humans; Infant, Newborn; Meconium; Pregnancy; Substance-Related Disorders

We determined the prevalence of prenatal cocaine use in a racially mixed sample of urban and suburban mothers and correlated its use with maternal demographics and newborn measurements.. Meconium from 621 consecutive newborns delivered at two university-affiliated urban hospitals were assayed for benzoylecgonine. Maternal and infant characteristics were linked anonymously with the results. Statistical analysis included t test, Fisher's exact test, Duncan's multiple range analysis, and analysis of covariance, with a value of p < 0.05 considered significant.. We found that 3.4% of meconium samples had benzoylecgonine levels exceeding 0.1 micrograms/ml. Its presence was statistically correlated with maternal and neonatal characteristics. A nurse's opinion of cocaine use was correct 22% of the time.. Prenatal cocaine use was statistically associated with multiparity, multigravidity, late-onset and clinic-based prenatal care, public assistance, nonwhite race, and low academic achievement. A nurse's opinion was a poor predictor of maternal cocaine use. Cocaine-exposed infants were significantly smaller, and this correlated best with nonwhite background.

Topics: Birth Weight; Cocaine; Female; Humans; Infant, Newborn; Meconium; Nurses; Pregnancy; Pregnancy Complications; Prenatal Care; Prevalence; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders; Suburban Population; Urban Population

To determine the rate of prenatal use of cocaine, cannabis, amphetamines, opiates, and cigarettes in rural midwestern women by analysis of reported use of cigarettes, maternal urine drug screening at admission to labor and delivery, and newborn meconium screening.. The cohort of all women presenting to labor and delivery and their newborns were screened by urine and meconium analysis. Demographic information was also collected and matched to the urine and meconium samples.. Four primary care hospitals in rural Minnesota. Hospitals range in size from 66 to 140 beds, with 400 to 780 deliveries each year.. All women presenting to labor and delivery for evaluation of term or preterm labor between April 4, 1991, and October 4, 1991.. Overall, drugs not administered during labor were found in a mean (+/- SD) of 3.2% +/- 1.1% of all urine screens. Cannabis was found in 1.2% +/- 0.7% of maternal urine samples, amphetamines in 0.8% +/- 0.58%, opiates in 1.2% +/- 0.7%, and cocaine in 0% +/- 0.3%. Meconium samples were positive in 1.8% +/- 0.9% of cases. Cannabis was found in 1.1% +/- 0.7% of meconium samples, opiates in 0.6% +/- 0.5%, and cocaine in 0.1% +/- 0.1%. No urine samples were positive for more than one drug. One meconium sample tested positive for both cocaine and cannabis. Nearly 4% of patients had either a positive urine specimen or a positive meconium specimen. By history, 24.5% of women admitted to smoking during pregnancy.. The use of cocaine, cannabis, opiates, and amphetamines was uncommon in this rural population. However, one quarter of the women admitted to smoking during pregnancy, exposing their fetuses to a dangerous substance.

Topics: Adult; Cohort Studies; Female; Humans; Infant, Newborn; Meconium; Middle Aged; Minnesota; Pregnancy; Pregnancy Complications; Rural Population; Substance Abuse Detection; Substance-Related Disorders

We studied the sensitivity of testing the newborn infant's hair, meconium, and urine in detecting gestational cocaine exposure. The infants were born to 59 women who were interviewed to determine their use of cocaine during pregnancy and whose hair was analyzed for the presence of cocaine. Regression analysis was used to evaluate the relationship between cocaine in newborn hair and in maternal hair. Radioimmunoassay of infants' hair and gas chromatography-mass spectrometry of meconium were more sensitive than immunoassay of urine (p less than 0.02), which failed to identify 60% of cocaine-exposed infants. The quantity of benzoylecgonine in the newborn infant's hair correlated best with the proximal-segment maternal hair, representing the last 12 weeks of antepartum hair growth (R = less than R less than 0.83). Approximately half (52%) of the variation in infants' hair was explained by variation in the proximal maternal hair segment. Correlation (R = 0.77) and explained variation (59%) improved slightly when premature infants (n = 9) were excluded. We conclude that analysis of the newborn infant's hair by radioimmunoassay or of meconium by gas chromatography-mass spectrometry is more sensitive than analysis by immunoassay of urine, and can detect fetal cocaine exposure that occurred during the last two trimesters of pregnancy.

Topics: Adult; Cocaine; Female; Gas Chromatography-Mass Spectrometry; Hair; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Radioimmunoassay; Sensitivity and Specificity; Substance Abuse Detection; Substance-Related Disorders

A large-scale, prospective drug screening of newborns by meconium analysis was done to determine more accurately the prevalence and epidemiologic characteristics of drug use in a high-risk urban, obstetric population. Every other neonate delivered in a perinatal center from November 1988 to September 1989 was prospectively enrolled and their meconium was analyzed by radioimmunoassay for the metabolites of three commonly abused drugs--cocaine, morphine (opiates), and cannabinoid. In 3010 subjects studied, 44% were positive for cocaine, morphine, or cannabinoid; 31% were positive for cocaine, 21% for morphine, and 12% for cannabinoid. In contrast, only 335 (11%) mothers admitted to illicit drug use: 52% of their newborns had a positive urine drug screen and 88% had a positive meconium drug screen. Prevalence of drug use among the pregnant women varied per month. A profile of the pregnant addict in the population studied was noted (P less than .001): service patient, single, multigravid (greater than 3), and little or no prenatal care. The major problems associated with drug use during pregnancy were principally noted in the group that was exposed to cocaine and opiates and in the group where the mothers admitted to the use of illicit drugs. On the other hand, a large number of neonates who have been exposed to drugs in utero, particularly those whose mothers denied the use of drugs, appear normal at birth and may not be recognized. Improved detection of these newborns at risk can be achieved with a high index of suspicion and meconium drug analysis.

Topics: Cannabis; Cocaine; Female; Humans; Infant, Newborn; Marijuana Abuse; Mass Screening; Meconium; Morphine; Morphine Dependence; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Prevalence; Prospective Studies; Sensitivity and Specificity; Substance-Related Disorders; United States

Topics: Female; Humans; Infant, Newborn; Meconium; Predictive Value of Tests; Pregnancy; Prevalence; Substance Abuse Detection; Substance-Related Disorders

Samples of meconium from 28 neonates born to women suspected of drug abuse were tested for drugs of abuse (ie, cocaine, morphine, codeine, and marijuana). In each case, testing of urine from the mother, the newborn, or both had been ordered by the attending physician because of suspected maternal drug abuse. Seventeen (61%) of 28 meconium samples tested positive; 28 (60%) of 47 urine samples were positive. Meconium test results were concordant with the results of maternal or newborn urine testing in 24 (86%) of the 28 cases. In three cases, meconium was positive for cocaine when newborn urine was negative; in one case, meconium was negative when maternal urine was positive for cocaine. Compared with the combination of maternal and newborn urine testing, meconium testing had an 82% positive predictive value (14/17) and a 91% negative predictive value (10/11). Collection of meconium is simpler and more reliable than collection of urine, and testing of meconium was easily incorporated into routine procedures at a busy commercial laboratory. Meconium is a useful sample for drug detection in newborns.

Topics: Cocaine; Female; Humans; Illicit Drugs; Infant, Newborn; Meconium; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Substance-Related Disorders

This study endeavored to determine the incidence of intrauterine cocaine exposure in a socioeconomically mixed suburban setting. It also assessed the effectiveness of an anonymous questionnaire in eliciting information on maternal use of illicit drugs during pregnancy. Meconium was collected from 500 consecutively born infants and analyzed for the presence of cocaine and its metabolites. An anonymous two-page questionnaire also was distributed to all postpartum mothers. Of the infants' mothers, (73.2%) were covered by some form of insurance (private), whereas 26.8% either had no insurance or were covered by Medicaid (clinic). Fifty-nine (11.8%) babies tested positive for cocaine. The meconium of 6.3% of the babies whose mothers had private insurance tested positive, while the meconium of 26.9% of the babies whose mothers had Medicaid or no insurance tested positive. 316 (63.2%) of the mothers returned a questionnaire. 73% had private insurance and 27% were covered by Medicaid (clinic). Only five mothers with no insurance or covered by Medicaid admitted using cocaine. It appears that neonatal exposure to cocaine may be an even greater problem than previously imagined, particularly in the private population. In addition, anonymous maternal self-reporting forms probably will not be helpful in identifying infants at risk for illicit exposure to drugs.

Topics: Cocaine; Female; Fetus; Humans; Maternal-Fetal Exchange; Meconium; Pregnancy; Pregnancy Complications; Socioeconomic Factors; Substance-Related Disorders; Suburban Population; Surveys and Questionnaires

Eighty-eight neonates born to mothers with a history of cocaine use during pregnancy were divided into two groups based upon the detection of cocaine metabolites in the first neonatal urine. Forty neonatal urine samples were positive for cocaine and 46 were negative. Preterm labor, premature rupture of membranes, and meconium-stained amniotic fluid were significantly more frequent in those mothers whose neonates tested positive for cocaine metabolites than in those whose infants were negative (P less than .05). Neonates testing positive were more likely to exhibit signs and symptoms of acute cocaine intoxication. Low birth weight, growth retardation, and abruptio placentae were also more frequent than would be expected in the general population, but were not statistically different between the groups. These findings suggest that the differences noted in the cocaine-positive group may represent acute and chronic exposure, whereas the negative group reflects the problems associated with chronic usage alone.

Topics: Amniotic Fluid; Cocaine; Female; Fetal Membranes, Premature Rupture; Humans; Incidence; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies; Substance-Related Disorders

Meconium specimens (first 3 days' stool) obtained from 20 infants of drug-dependent mothers and five control infants were analyzed by radioimmunoassay for the metabolites of three commonly abused drugs, heroin, cocaine, and cannabinoids. Control stools contained no drug. Meconium from the infants of drug-dependent mothers showed the presence of at least one drug metabolite: 80% of the infants of drug-dependent mothers showed cocaine (range 0.14 to 19.91 micrograms/gm stool), 55% showed morphine (range 0.41 to 14.97 micrograms/gm stool), and 60% showed cannabinoid (range 0.05 to 0.67 micrograms/gm stool). The concentrations of metabolites were highest during the first 2 days; some stools tested positive up to the third day. In contrast, only 37% of the infants had positive results on a urine screen (fluorescent polarization immunoassay method). Paired urine and meconium specimens, both analyzed by radioimmunoassay, showed a higher concentration of drug metabolites in the latter; eight urine samples had no detectable drugs despite a corresponding positive stool test result. We conclude that meconium is useful for drug screening in the neonate.

Topics: Animals; Cannabinoids; Cocaine; Feces; Female; Heroin; Humans; Infant, Newborn; Mass Screening; Maternal-Fetal Exchange; Meconium; Morphine; Predictive Value of Tests; Pregnancy; Psychotropic Drugs; Rats; Rats, Inbred Strains; Substance-Related Disorders

Topics: False Negative Reactions; Female; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Pregnancy; Substance-Related Disorders

A series of novel 2- and 3-acylmorphinans (8-14) was synthesized in our search for a potent analgesic agent with low addiction potential. The compounds were evaluated for antinociceptive potency and receptor binding affinity. Among these compounds, the levorotatory 3-acetyl-N-(cyclopropylmethyl)morphinan (12) was found to be an orally active analgesic, comparable in potency to morphine (1), yet only weakly able to substitute for morphine (1) in morphine-dependent rats.

Topics: Analgesia; Animals; Chemical Phenomena; Chemistry; Codeine; Humans; Levorphanol; Magnetic Resonance Spectroscopy; Morphinans; Morphine; Rats; Receptors, Opioid; Substance-Related Disorders

A series of 8-alkyl-3-methoxy-17-methylmorphinan-6-ones (3C) and -isomorphinan-6-ones (3T) were prepared by conjugate addition of lithium dialkylcuprates to the corresponding 7,8-didehydro-6-ones 2C and 2T. These 17-methyl compounds were potent analgesics and were converted to mixed narcotic agonists-antagonists 7-10, by replacement of the 17-methyl groups with cycloalkylmethyl moieties. The 8 substituent modified the type of activity observed. One of these compounds, 17-(cyclobutylmethyl)-3-hydroxy-8 beta-methylmorphinan-6-one (10Ca), had an agonist-antagonist ratio of 0.1. Compound 10Ca did not support or cause dependence in rats. This compound, however, appeared to be a typical narcotic agent in morphine-dependent monkeys.

Topics: Acetates; Analgesics; Animals; Haplorhini; Humans; Mice; Morphinans; Morphine Dependence; Narcotic Antagonists; Rats; Reaction Time; Structure-Activity Relationship; Substance Withdrawal Syndrome; Substance-Related Disorders