1
|
Carrilero N, García-Altés A. Health inequalities in childhood diseases: temporal trends in the inter-crisis period. Int J Equity Health 2024; 23:76. [PMID: 38632575 PMCID: PMC11025183 DOI: 10.1186/s12939-024-02169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age. METHODS A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014-2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends. RESULTS Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p = < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls. CONCLUSIONS Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them.
Collapse
Affiliation(s)
- Neus Carrilero
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.
- Department of Medicine and Life Sciences (MELIS-UPF), Pompeu Fabra University, Barcelona, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) , Barcelona, Spain.
- Research Group on Primary and Community Care in Barcelona (APICBA), Hospital del Mar Research Institute, Barcelona, Spain.
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
| | - Anna García-Altés
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
2
|
Vila-Farinas A, Pérez-Ríos M, Montes-Martínez A, Trinanes-Pego Y, Varela-Lema L. [Considerations for the design and implementation of interventions for the cessation of tobacco, alcohol and cannabis use in pregnancy: A qualitative study]. Aten Primaria 2023; 55:102732. [PMID: 37573833 PMCID: PMC10448272 DOI: 10.1016/j.aprim.2023.102732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE To explore the opinion of different key stakeholders regarding the requirements that tobacco, alcohol and/or cannabis cessation interventions should meet to be implemented and to be acceptable and useful during pregnancy. DESIGN A qualitative study with phenomenological approach. SITE: The study was conducted in Spain in 2022. PARTICIPANTS Decision makers, health professionals, pregnant women using tobacco, alcohol and/or cannabis and their partners who are also users. METHODS Data were collected through focus groups and in-depth interviews, until discourse saturation was reached and accurately transcribed. Exploratory analysis and inductive open coding were conducted, codes were merged into categories and subcategories were identified. RESULTS Four categories and 18 subcategories were identified. The results suggest that interventions should be multicomponent. Among the interventions most accepted by pregnant women and their partners were specific cessation consultations, information, peer support (although they did not specify how) and financial incentives. Among other options to consider, co-oximetry, proposed by managers to obtain an objective register. CONCLUSIONS The conclusion is that this intervention should be carried out at the level of prenatal care in primary care. There are doubts regarding the frequency, purpose, and follow-up of this multicomponent intervention, as well as the possibility of incorporating couples.
Collapse
Affiliation(s)
- Andrea Vila-Farinas
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España
| | - Mónica Pérez-Ríos
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España.
| | - Agustín Montes-Martínez
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España
| | - Yolanda Trinanes-Pego
- Unidad de Asesoramiento Científico-técnico (Avalia-t). Agencia Gallega de Conocimiento en Salud (ACIS), Galicia , España
| | - Leonor Varela-Lema
- Departamento de Medicina Preventiva y Salud Pública, Universidade de Santiago de Compostela, Santiago de Compostela , España; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela , España
| |
Collapse
|
3
|
Towobola A, Towobola B, Nair B, Makwana A. The ethics and management of cannabis use in pregnancy following decriminalisation and licensing for medical use: narrative review. BJPsych Bull 2023; 47:28-37. [PMID: 34749839 PMCID: PMC10028554 DOI: 10.1192/bjb.2021.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIMS AND METHOD As drug policies pertaining to cannabis use become more liberalised, the prevalence of cannabis use in pregnancy could increase. However, there is limited guidance available for clinicians. This paper presents a narrative review of literature published in the past 16 years (2006-2021) to (a) address the impact of legalisation and decriminalisation on the risks, ethics and support of women who use cannabis during pregnancy and (b) develop guidance for clinicians. RESULTS Both national and international trends suggest increased use of cannabis over the past decade, while the risks of cannabis use for recreational or medicinal purposes in pregnancy remain unmitigated. CLINICAL IMPLICATIONS This review confirmed that the recommendation of cannabinoid-based products for pregnant and breast-feeding women is currently premature. More research is needed to address safety concerns. We discussed navigating ethical concerns and suggest targeted management strategies for clinicians treating pregnant women who choose to use cannabis.
Collapse
Affiliation(s)
| | | | - Bosky Nair
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| | - Arti Makwana
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| |
Collapse
|
4
|
Jones J. Toxicology as a diagnostic tool to identify the misuse of drugs in the perinatal period. Front Pediatr 2022; 10:1071564. [PMID: 36843886 PMCID: PMC9944414 DOI: 10.3389/fped.2022.1071564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/23/2022] [Indexed: 02/11/2023] Open
Abstract
The use, misuse, and abuse of substances are a continued public health concern in this country and around the world. Perinatal exposure to substances of abuse is associated with several long-term negative consequences for the neonate. Limited resources exist to assist perinatal health professionals on this very complex subject. The purpose of this document is to provide additional information about selecting monitoring protocols, the specifics of appropriate testing methodologies, and the interpretation of toxicological findings. Understanding these concepts better allows perinatal healthcare professionals to be a voice for the voiceless in order to protect and enrich lives during this unprecedented opioid epidemic.
Collapse
Affiliation(s)
- Joseph Jones
- United States Drug Testing Laboratories, Des Plaines, IL, United States
| |
Collapse
|
5
|
Moreno-Ramos M, Sánchez-Barba M, Sánchez RG, Mirón-Canelo JA, González-Nuñez V. Incidence of Neonatal Abstinence Syndrome (NAS) in Castilla y Leon (Spain). CHILDREN 2021; 9:children9010025. [PMID: 35053650 PMCID: PMC8774299 DOI: 10.3390/children9010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/27/2021] [Indexed: 12/03/2022]
Abstract
Introduction: Neonatal Abstinence Syndrome (NAS) is considered a Public Health problem that is defined as a group of symptoms that appear in the newborn due to withdrawal from intrauterine drug exposure. Objective: The aim of this study was to analyze the incidence of NAS in Castilla y León from 2000 to 2019. Methodology: Data of NAS cases in Castilla y León from 2000 to 2019 were obtained. NAS incidence per 1000 births was calculated and the correlation among data from different provinces and years was analyzed. Results: The cumulative incidence of NAS in Castilla y León per 1000 births between 2000-2019 was 0.91‰, with great interprovincial variability. The provinces of Zamora and Palencia stand out, with high incidence rates of NAS despite their low birth rates. The temporal trend points towards a decrease in incidence from 2000 to 2019. Opioids such as methadone, cannabis, benzodiazepines and poly-drug use are the most prevalent drugs causing NAS, and it has also been observed that methadone is being replaced by cannabis as the major cause of NAS cases at the University Hospital in Salamanca in recent years. Conclusions: The incidence of NAS in Castilla y León decreased in 2004 and remained constant until 2019, but it shows great interprovincial variability. It is necessary to implement a national NAS Registry to obtain comprehensive information regarding its incidence.
Collapse
Affiliation(s)
| | - Mercedes Sánchez-Barba
- Department of Statistics, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Institute of Biomedical and Diagnostic Sciences (IBSAL), 37007 Salamanca, Spain
| | - Rubén García Sánchez
- Department of Pediatrics, University Hospital of Salamanca, 37008 Salamanca, Spain;
| | - José Antonio Mirón-Canelo
- Institute of Biomedical and Diagnostic Sciences (IBSAL), 37007 Salamanca, Spain
- Department of Biomedical and Diagnostic Sciences, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
- Instituto de Neurociencias de Castilla y León (INCYL), University of Salamanca, 37008 Salamanca, Spain
- Correspondence: (J.A.M.-C.); (V.G.-N.)
| | - Veronica González-Nuñez
- Institute of Biomedical and Diagnostic Sciences (IBSAL), 37007 Salamanca, Spain
- Instituto de Neurociencias de Castilla y León (INCYL), University of Salamanca, 37008 Salamanca, Spain
- Department Biochemistry and Molecular Biology, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
- Correspondence: (J.A.M.-C.); (V.G.-N.)
| |
Collapse
|
6
|
Roca A, Jarque P, Gomila I, Marchei E, Tittarelli R, Elorza MÁ, Sanchís P, Barceló B. Clinical features and risk factors associated with prenatal exposure to drugs of abuse. An Pediatr (Barc) 2021; 95:307-320. [PMID: 34635463 DOI: 10.1016/j.anpede.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Early identification of neonates exposed to drugs of abuse during pregnancy allows a more precise clinical management. OBJECTIVES To describe the clinical characteristics and to identify risk factors associated with the early detection of neonates exposed to drugs of abuse in a Neonatal Intermediate and Intensive Care Unit. METHODS Prospective observational study of neonates with and without clinical suspicion of prenatal exposure to drugs of abuse. Meconium was analyzed using standard chromatographic techniques. Univariate and multivariate statistical analyzes were performed. RESULTS 372 neonates were included. Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one. Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol. In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one. The most clinically relevant independent risk factors useful to detect cases of prenatal exposure to drugs of abuse were (Odds ratio (95% CI)): reason for admission other than prematurity (5.52 (2.55-1.93)), length percentile less than 33 (1.95 (1.05-3.60) and 2.14 (1.04-3.40) in older than 34 PW) and social dystocia/uncontrolled pregnancy in older than 34 PW (4.47 (1.03-19.29)). CONCLUSIONS There are somatometric alterations and risk factors that can help in the early detection of neonates exposed to drugs of abuse. The somatometric alterations identified can be useful to extend the differential diagnosis of these alterations and to study their causes.
Collapse
Affiliation(s)
- Antonia Roca
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pilar Jarque
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Isabel Gomila
- Servicio de Análisis Clínicos, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Emilia Marchei
- Centro Nacional de Adicciones y Dopaje, Instituto Superior de Salud, Roma, Italy
| | - Roberta Tittarelli
- Unidad de Toxicología Forense, Departamento de Ciencias Anatómicas, Histológicas, Forenses y Ortopédicas, Universidad de Sapienza, Roma, Italy
| | - Miguel Ángel Elorza
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Pilar Sanchís
- Departamento de Química, Universidad de las Islas Baleares, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain
| | - Bernardino Barceló
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, Spain; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, Spain.
| |
Collapse
|
7
|
Jarque P, Roca A, Gomila I, Marchei E, Tittarelli R, Elorza MÁ, Sanchís P, Barceló B. Role of Neonatal Biomarkers of Exposure to Psychoactive Substances to Identify Maternal Socio-Demographic Determinants. BIOLOGY 2021; 10:biology10040296. [PMID: 33916618 PMCID: PMC8067052 DOI: 10.3390/biology10040296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary The rapid identification of newborns exposure to psychoactive drugs allows an appropriate clinical care. This study tried to identify maternal profiles that help to identify newborns exposed to psychoactive drugs during pregnancy. Mothers were interviewed using a questionnaire. The biomarkers of fetal exposure were measured in meconium samples. Statistical analysis was performed to identify the maternal characteristics that were most likely to be associated with drug use during pregnancy. Of a total of 372 mothers, 49 (13.2%) tested positive for psychoactive drugs use: 24 (49.0%) for cannabis, 11 (22.5%) for ethyl glucuronide, six (12.2%) for cocaine, and eight (16.3%) for more than one psychoactive substance. The maternal characteristics that most likely identify substance use during pregnancy are: maternal age < 24 years, lack of pregnancy care, single-mother families, and active tobacco smoking. The profiles of prenatal maternal exposure identified in a clinical setting can be used to request specific detection tests for identifying newborns exposed to these drugs. Abstract Background: The accurate assessment of fetal exposure to psychoactive substances provides the basis for appropriate clinical care of neonates. The objective of this study was to identify maternal socio-demographic profiles and risk factors for prenatal exposure to drugs of abuse by measuring biomarkers in neonatal matrices. Methods: A prospective, observational cohort study was completed. Biomarkers of fetal exposure were measured in meconium samples. The mothers were interviewed using a questionnaire. Univariate and multivariate logistic regression analyses were performed. Results: A total of 372 mothers were included, 49 (13.2%) testing positive for psychoactive substances use: 24 (49.0%) for cannabis, 11 (22.5%) for ethyl glucuronide, six (12.2%) for cocaine, and in eight (16.3%) more than one psychoactive substance. Mothers who consumed any psychoactive substance (29.7 ± 6.6 years) or cannabis (27.0 ± 5.7 years) were younger than non-users (32.8 ± 6.2 years, p < 0.05). Cocaine (50.0% vs. 96.9%, p < 0.05) and polydrug users (37.5% vs. 96.9%, p < 0.05) showed a lower levels of pregnancy care. Previous abortions were associated with the use of two or more psychoactive substances (87.5% vs. 37.8%, p < 0.05). Single-mother families (14.3% vs. 2.5%, p < 0.05) and mothers with primary level education (75.5% vs. 55.1%, p < 0.05) presented a higher consumption of psychoactive substances. Independent risk factors that are associated with prenatal exposure include: maternal age < 24 years (odds ratio: 2.56; 95% CI: 1.12–5.87), lack of pregnancy care (odds ratio: 7.27; 95%CI: 2.51–21.02), single-mother families (odds ratio: 4.98; 95%CI: 1.37–8.13), and active tobacco smoking (odds ratio: 8.13; 95%CI: 4.03–16.43). Conclusions: These results will allow us to develop several risk-based drug screening approaches to improve the early detection of exposed neonates.
Collapse
Affiliation(s)
- Pilar Jarque
- Department of Pediatrics, Division of Neonatology, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain; (P.J.); (A.R.)
- Pediatric Multidisciplinary Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Antonia Roca
- Department of Pediatrics, Division of Neonatology, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain; (P.J.); (A.R.)
- Pediatric Multidisciplinary Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Isabel Gomila
- Clinical Analysis Service, Son Llàtzer University Hospital, Manacor Road, 07198 Palma de Mallorca, Spain;
- Clinical Toxicology Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain;
| | - Emilia Marchei
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy;
| | - Roberta Tittarelli
- Department of Anatomical, Unit of Forensic Toxicology, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Rome, Italy;
| | - Miguel Ángel Elorza
- Clinical Toxicology Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain;
- Clinical Analysis Service, Clinical Toxicology Unit, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Pilar Sanchís
- Department of Chemistry, University of the Balearic Islands, Valldemossa Road, km 7.5, 07122 Palma de Mallorca, Spain;
- Research Group in Vascular and Metabolic Pathologies, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
| | - Bernardino Barceló
- Clinical Toxicology Research Group, Balearic Islands Health Research Institute (IdISBa), Valldemossa Road, 79, 07120 Palma de Mallorca, Spain;
- Clinical Analysis Service, Clinical Toxicology Unit, Son Espases University Hospital, Valldemossa Road, 79, 07120 Palma de Mallorca, Spain
- Correspondence: ; Tel.: +34-871205000 (ext. 65476)
| |
Collapse
|
8
|
Tavella RA, DE Abreu VOM, Muccillo-Baisch AL, DA Silva JÚnior FMR. Prevalence of Illicit Drug Use During Pregnancy: A Global Perspective. AN ACAD BRAS CIENC 2020; 92:e20200302. [PMID: 33295578 DOI: 10.1590/0001-3765202020200302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022] Open
Abstract
The World Drug Report 2019 presented an alarming figure to the world: more than 5% of the world's population has been using some type of illicit drug, and that number is growing every year. While its use increases, its abuse during pregnancy has become a global public health problem, resulting in medical and social challenges related to maternal and child health. In this context, the objective of this review was to determine the prevalence of illicit drug use during gestation across the globe, alongside with a critical review of the evaluated studies. Research was performed by simultaneously searching terms ("pregnant woman OR pregnant" OR "gestation" OR "pregnancy" AND "illicit drugs" OR "street drugs") in the databases of the Scientific Electronic Library Online, PubMed, and Web of Science. Comparisons between studies were performed in software Statistica 10.0. The data presented worrying results in relation to the variation in prevalence of illicit drug use during pregnancy, when comparing studies based on interviews or questionnaires (self-reported) (1.65%) and studies based on toxicological analysis (12.28%). In addition, we emphasize the high prevalence (5.16%) of illicit drug use among adolescent pregnant women and the low number of studies on this population. This study reveals worrying data about pregnant drug-user population, mainly the underestimation of prevalence in studies that use only questionnaires or similar methods in comparison to studies that use toxicological analysis of biological matrices. This scenario reveals necessity for health systems in different countries to establish specific public health policies for this population.
Collapse
Affiliation(s)
- Ronan A Tavella
- Universidade Federal do Rio Grande, Instituto de Ciências Biológicas, Campus Carreiros, Av. Itália, Km 8, 96203-900 Rio Grande, RS, Brazil
| | - VictÓria O M DE Abreu
- Universidade Federal do Rio Grande, Faculdade de Medicina, Campus Saúde, Rua General Osório, s/n, 96201-900 Rio Grande, RS, Brazil
| | - Ana Luiza Muccillo-Baisch
- Universidade Federal do Rio Grande, Centro Regional para Estudos, Prevenção e Recuperação de Dependentes Químicos, Campus Saúde, Rua General Osório, s/n, 96201-900 Rio Grande, RS, Brazil
| | - FlÁvio M R DA Silva JÚnior
- Universidade Federal do Rio Grande, Instituto de Ciências Biológicas, Campus Carreiros, Av. Itália, Km 8, 96203-900 Rio Grande, RS, Brazil
| |
Collapse
|
9
|
González-Colmenero E, Concheiro-Guisán A, Lorenzo-Martínez M, Concheiro M, Lendoiro E, de-Castro-Ríos A, Cañizo-Vázquez D, Martínez-Reglero C, Fernández-Lorenzo JR. Drug testing in biological samples vs. maternal surveys for the detection of substance use during whole pregnancy. J Addict Dis 2020; 39:175-182. [PMID: 33043834 DOI: 10.1080/10550887.2020.1831137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early diagnosis of nicotine, ethanol and drug use during pregnancy is critical in order to provide adequate care. Current screening procedures show limitations in terms of reliability and short windows of detection. OBJECTIVES To investigate the prevalence and identify biomarkers of substance use and changes in substance use during pregnancy. To compare drug testing results in different types of biological samples (maternal hair, meconium, placenta, umbilical-cord) with self-reported data. PARTICIPANTS AND SETTING Prospective cohort study using data from pregnant women and their newborns. METHODS Biological matrices were collected at birth and analyzed by liquid chromatography tandem mass spectrometry. A paper survey was provided to determine substance use habits. RESULTS 867 mother-newborn pairs were included. According to the analysis of biological samples, 29.1% cases were positive for one or more substances (13.6% nicotine, 8.4% ethanol, 8.3% cocaine, 6.4% cannabis, 5.7% opioids). The profile of the substance-using mother was a single woman, <28 years-old, with no higher education and unemployed. Segmental maternal hair analysis showed a decrease in tobacco, cannabis and cocaine use throughout pregnancy (p < 0.001). The level of concordance between results from interviews and from biological analyses was weak for opioids, cocaine, and cannabis (kappa coefficient < 0.40). Maternal hair detected the highest number of cases, followed by meconium and by placenta and/or umbilical-cord. CONCLUSIONS Maternal survey was not a reliable screening technique. Analysis of maternal hair detected the highest number of cases with the broadest detection window (whole pregnancy).
Collapse
Affiliation(s)
- Eva González-Colmenero
- Department of Neonatology, Hospital Álvaro Cunqueiro, Vigo, Galicia, Spain.,Pediatrics Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO
| | - Ana Concheiro-Guisán
- Department of Neonatology, Hospital Álvaro Cunqueiro, Vigo, Galicia, Spain.,Pediatrics Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO
| | | | - Marta Concheiro
- John Jay College of Criminal Justice, City University of New York, New York, USA
| | - Elena Lendoiro
- Servizo de Toxicoloxía. Instituto de Ciencias Forenses, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Ana de-Castro-Ríos
- Servizo de Toxicoloxía. Instituto de Ciencias Forenses, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | | | - Cristina Martínez-Reglero
- Metodology and Statistic Department, Galicia Sur Health Research Institute (IIS Galicia Sur), Hospital Álvaro Cunqueiro, Vigo, Galicia, Spain
| | - José Ramón Fernández-Lorenzo
- Department of Neonatology, Hospital Álvaro Cunqueiro, Vigo, Galicia, Spain.,Pediatrics Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO
| |
Collapse
|
10
|
Roca A, Jarque P, Gomila I, Marchei E, Tittarelli R, Elorza MÁ, Sanchís P, Barceló B. [Clinical features and risk factors associated with prenatal exposure to drugs of abuse]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30285-X. [PMID: 33041240 DOI: 10.1016/j.anpedi.2020.08.003] [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: 06/23/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Early identification of neonates exposed to drugs of abuse during pregnancy allows a more precise clinical management. OBJECTIVES To describe the clinical characteristics and to identify risk factors associated with the early detection of neonates exposed to drugs of abuse in a Neonatal Intermediate and Intensive Care Unit. METHODS Prospective observational study of neonates with and without clinical suspicion of prenatal exposure to drugs of abuse. Meconium was analyzed using standard chromatographic techniques. Univariate and multivariate statistical analyzes were performed. RESULTS 372 neonates were included. Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one. Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol. In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one. The most clinically relevant independent risk factors useful to detect cases of prenatal exposure to drugs of abuse were (Odds ratio (95% CI)): reason for admission other than prematurity (5.52 (2.55-1.93)), length percentile less than 33 (1.95 (1.05-3.60) and 2.14 (1.04-3.40) in older than 34 PW) and social dystocia/uncontrolled pregnancy in older than 34 PW (4.47 (1.03-19.29)). CONCLUSIONS There are somatometric alterations and risk factors that can help in the early detection of neonates exposed to drugs of abuse. The somatometric alterations identified can be useful to extend the differential diagnosis of these alterations and to study their causes.
Collapse
Affiliation(s)
- Antonia Roca
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Pilar Jarque
- Unidad de Neonatología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Isabel Gomila
- Servicio de Análisis Clínicos, Hospital Universitario Son Llàtzer, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España
| | - Emilia Marchei
- Centro Nacional de Adicciones y Dopaje, Instituto Superior de Salud, Roma, Italia
| | - Roberta Tittarelli
- Unidad de Toxicología Forense, Departamento de Ciencias Anatómicas, Histológicas, Forenses y Ortopédicas, Universidad de Sapienza, Roma, Italia
| | - Miguel Ángel Elorza
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España
| | - Pilar Sanchís
- Departamento de Química, Universidad de las Islas Baleares, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España
| | - Bernardino Barceló
- Servicio de Análisis Clínicos, Unidad de Toxicología Clínica, Hospital Universitario Son Espases, Palma de Mallorca, España; Instituto de Investigación Sanitaria de las Islas Baleares (IdISBa), Palma de Mallorca, España.
| |
Collapse
|
11
|
Roncero C, Valriberas-Herrero I, Mezzatesta-Gava M, Villegas JL, Aguilar L, Grau-López L. Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders. A systematic review. Reprod Health 2020; 17:25. [PMID: 32066469 PMCID: PMC7027300 DOI: 10.1186/s12978-020-0880-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/10/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION This study analyze factors associated to cannabis use in pregnant women, its perceived availability, its risk perception and the relationship between prenatal exposure to cannabis and developmental and mental disorders. OBJECTIVES We present a review of the literature on cannabis use among pregnant women. The objective is to analyze factors associated to cannabis use during pregnancy and assess the potential effects of prenatal exposure to cannabis on the development of the fetus and the mental health of those exposed. METHODS Systematic review of studies on the maternal use of cannabis and the relationship between early exposure and the development of psychiatric disorders in the PubMed database until July 2018 in English and Spanish with the following keywords: Marijuana, Cannabinoids, Mental disorders, Pregnancy, Prenatal Cannabis Exposure, Risk factors. RESULTS The use of cannabis among pregnant women is frequent but it has not been extensively researched. Prenatal exposure to cannabis may be associated with affective symptoms and ADHD. CONCLUSIONS Mental healthcare professionals who treat women during their fertile life need to be able to explain the relationship between prenatal exposure to cannabis and the presence of developmental and mental disorders.
Collapse
Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain. .,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain.
| | - Isabel Valriberas-Herrero
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Marcela Mezzatesta-Gava
- Multidisciplinary Unit of Autism Spectrum Disorder (UnimTEA), Mental Health Department, Sant Joan de Deu Hospital, Barcelona, Spain
| | - José L Villegas
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Lourdes Aguilar
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain.,Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Lara Grau-López
- Addiction and Dual Diagnosis Unit, Psychiatric Service, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain.,Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Psychiatry and Forensic Medicine, Autonomus University of Barcelona, Barcelona, Spain
| |
Collapse
|
12
|
Serum concentrations of IGF-I/IGF-II as biomarkers of alcohol damage during foetal development and diagnostic markers of Foetal Alcohol Syndrome. Sci Rep 2019; 9:1562. [PMID: 30733584 PMCID: PMC6367511 DOI: 10.1038/s41598-018-38041-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/30/2018] [Indexed: 12/23/2022] Open
Abstract
Foetal Alcohol Syndrome (FAS) is the most deleterious health effect derived from alcohol consumption during pregnancy and is placed at the end of the Foetal Alcohol Spectrum Disorders (FASD). Few studies have proposed potential molecular biomarkers of physical and neurological damage associated with prenatal alcohol exposure. We prospectively recruited 55 children from 8 to 12 years old, with a prenatal assessment for ethanol exposure using meconium analysis of fatty acid ethyl esters (FAEE). The control group was established for FAEE < 2 nmol/g (n = 31) and a Prenatal Ethanol Exposure (PEE) group for FAEEs > 2 nmol/g (n = 33). Moreover, 98 children adopted from Eastern European Countries (EEC) were also recruited to evaluate FASD diagnosis comprising 31 cases with complete FAS, 42 with partial FAS, 6 with ARBD and 5 with ARND. Serum values of IGF-I and IGF-II for all children recruited were determined by immunoassay. Anthropometric and neurocognitive evaluation showed severe impairments in FAS children, moderate effects in PEE and no harmful effects in the control group with no prenatal exposure to alcohol. Analysis of IGF-I and IGF-II serum concentrations revealed that FASD from EEC as well as PEE children showed significantly lower concentrations of both IGF-I and IFG-II than the control group and reference values. Moreover, Spearman correlations showed a significant effect of IGF-I on anthropometric measurements in girls, whereas IGF-II affected the neuropsychological variables in both genders. These findings validate the use of growth factors IGF-I and IGF-II as surrogate biomarkers of damage induced by prenatal exposure to ethanol and could be used in the diagnosis of foetal alcohol spectrum disorders.
Collapse
|
13
|
Mendoza R, Morales-Marente E, Palacios MS, Rodríguez-Reinado C, Corrales-Gutiérrez I, García-Algar Ó. Health advice on alcohol consumption in pregnant women in Seville (Spain). GACETA SANITARIA 2019; 34:449-458. [PMID: 30733046 DOI: 10.1016/j.gaceta.2018.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyse to what extent pregnant women remembered having received health advice regarding alcohol consumption during pregnancy, what the message they perceived was and whether there is social inequality in this regard. METHOD A cross-sectional descriptive study was performed with a sample of 426 pregnant women (in their 20th week of pregnancy) receiving care in the outpatient clinics of a university hospital in a southern Spanish city (Seville). The data were collected through face-to-face structured interviews carried out by trained health professionals. RESULTS 43% of the interviewed women stated that they had not received any health advice in this regard. Only 43.5% of the sample remembered having received the correct message (not to consume any alcohol at all during pregnancy) from their midwife, 25% from their obstetrician and 20.3% from their general practitioner. The women with a low educational level were those who least declared having received health advice on the issue. CONCLUSION The recommended health advice to avoid alcohol consumption during pregnancy does not effectively reach a large proportion of pregnant women. Developing institutional programmes which help healthcare professionals to carry out effective preventive activities of foetal alcohol spectrum disorder is needed.
Collapse
Affiliation(s)
- Ramón Mendoza
- Department of Social, Developmental and Educational Psychology, University of Huelva, Huelva, Spain; Research Group on Health Promotion and Development of Lifestyle across the Life Span, University of Huelva, Huelva, Spain
| | - Elena Morales-Marente
- Department of Social, Developmental and Educational Psychology, University of Huelva, Huelva, Spain; Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO)
| | - M Soledad Palacios
- Department of Social, Developmental and Educational Psychology, University of Huelva, Huelva, Spain; Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO)
| | - Carmen Rodríguez-Reinado
- Research group in Social Studies and Social Intervention, Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO), University of Huelva, Huelva, Spain
| | | | - Óscar García-Algar
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clínic-Maternitat, BCNatal, Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Planas S, Andreu-Fernández V, Martín M, de Castro-Catala M, Bastons-Compta A, García-Algar O, Rosa A. Dermatoglyphics in children prenatally exposed to alcohol: Fluctuating asymmetry (FA) as a biomarker of alcohol exposure. Early Hum Dev 2018; 127:90-95. [PMID: 30393042 DOI: 10.1016/j.earlhumdev.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/17/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Dermatoglyphics alterations have been demonstrated to be an effective complement in the diagnosis of developmental disorders and a marker of prenatal stress. Several genetic and environmental factors can modify their morphology. Once defined, dermatoglyphics remain constant throughout life, being considered fossilized markers of the intrauterine development. Variations in bilateral morphological traits within an individual reflect developmental disturbances and can be measured by fluctuating asymmetry. The aim of this study was to evaluate if dermatoglyphic variations can be used as a surrogate marker prenatal alcohol exposure (PAE) during foetal development. Dermatoglyphics from 58 individuals who were either exposed or non-exposed to alcohol during pregnancy (according to the levels of Fatty Acid Ethyl Ethers (FAEE) found in meconium at birth) were analyzed. METHODS Total a-b ridge count (TABRC) and levels of fluctuating asymmetry from the a-b ridge count (FAABRC) were obtained. RESULTS A significant correlation between FA and FAEE levels was found in prenatally alcohol exposed individuals (r = 0.64, p = 0.0032). Remarkably, samples with highest values of FAEEs showed greater FAABRC (6.33 ± 4.18) levels than the values of non-exposed to alcohol (2.87 ± 1.74) as well as the exposed at low concentrations (2.6 ± 1.43) (U = 61, p = 0.05 and U = 14.5, p = 0.05, respectively). CONCLUSION Heavy prenatal ethanol exposure (demonstrated by high levels of FAEEs) alters the neuroectoderm developmental program during pregnancy: PAE correlates with FAABRC, which behaves as a dermatoglyphic variable sensitive to FASD and deserves to be studied as a surrogate marker of neurodevelopmental damage during foetal development.
Collapse
Affiliation(s)
- Sabina Planas
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infància i Entorn (GRIE), Servicio de Neonatología, Hospital Clínic-Maternitat, ICGON, IDIBAPS, BCNatal, Barcelona, Spain; Red de Salud Materno-Infantil y del Desarrollo (SAMID), Programa RETICS, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Martín
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain
| | - Marta de Castro-Catala
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
| | - Adriana Bastons-Compta
- Grup de Recerca Infància i Entorn (GRIE), Servicio de Neonatología, Hospital Clínic-Maternitat, ICGON, IDIBAPS, BCNatal, Barcelona, Spain; Red de Salud Materno-Infantil y del Desarrollo (SAMID), Programa RETICS, Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar García-Algar
- Grup de Recerca Infància i Entorn (GRIE), Servicio de Neonatología, Hospital Clínic-Maternitat, ICGON, IDIBAPS, BCNatal, Barcelona, Spain; Red de Salud Materno-Infantil y del Desarrollo (SAMID), Programa RETICS, Instituto de Salud Carlos III, Madrid, Spain
| | - Araceli Rosa
- Secció de Zoologia i Antropologia Biològica, Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
15
|
Analysis of prenatal abuse in Catalonia between the years 2011 and 2014. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
16
|
Chiandetti A, Hernandez G, Mercadal-Hally M, Alvarez A, Andreu-Fernandez V, Navarro-Tapia E, Bastons-Compta A, Garcia-Algar O. Prevalence of prenatal exposure to substances of abuse: questionnaire versus biomarkers. Reprod Health 2017; 14:137. [PMID: 29070078 PMCID: PMC5657059 DOI: 10.1186/s12978-017-0385-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 09/12/2017] [Indexed: 01/18/2023] Open
Abstract
Alcohol and drugs of abuse consumption in young adults, including women of childbearing age, has experienced significant increase over the past two decades. The use of questionnaires as the only measure to investigate prenatal alcohol and drugs of abuse exposure underestimates the real prevalence of exposure and could mislead to wrong conclusions. Therefore, the aim of this article was to compare reported rates of prenatal alcohol and drugs of abuse consumption with biomarkers of exposure by a comprehensive review of the available literature. We searched MEDLINE and EMBASE databases for articles catalogued between 1992 and 2015. We identified relevant published studies that assessed the comparison between prenatal exposure to alcohol and drugs of abuse assessed by self-reported questionnaire of consumption versus biomarkers of exposure. Thirteen studies were included regarding alcohol consumption, and seven of them about drugs of abuse. Women who admitted consumption during pregnancy by questionnaire varied from 0 to 37% for alcohol, from 0 to 4.3% for cocaine, and 2.9% for tetrahydrocannabinol (THC). Positive biomarkers results ranged from 16 to 44% for alcohol, 15.4% for cocaine, and from 4 to 12.4% for THC. Biomarkers should always complement questionnaires, as it has been shown that self-report may underestimate prenatal exposure to substances of abuse.
Collapse
Affiliation(s)
- Antonella Chiandetti
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gimena Hernandez
- Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Grup de Recerca en Farmacologia (GRF), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María Mercadal-Hally
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Airam Alvarez
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain.,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Vicente Andreu-Fernandez
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Elisabet Navarro-Tapia
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Adriana Bastons-Compta
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain
| | - Oscar Garcia-Algar
- Grup de Recerca Infància i Entorn (GRIE), Neonatology Unit, Hospital Clinic-Maternitat, BCNatal, C/Sabino Arana 1, 08028, Barcelona, Spain. .,Department de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| |
Collapse
|
17
|
Garcia Garcia J, Campistol Mas E, López-Vilchez MÁ, Morcillo Buscato MJ, Mur Sierra A. [Analysis of prenatal abuse in catalonia between the years 2011 and 2014]. An Pediatr (Barc) 2017; 88:150-159. [PMID: 28668338 DOI: 10.1016/j.anpedi.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Foetal abuse is that intentional or negligent act that causes a harmful effect to the foetus. It is a type of abuse difficult to diagnose and handle. Some indicators of suspicion are the absence of gestational control, the maternal consumption of toxic substances, or the problematic maternal social environment. OBJECTIVE To analyse the cases of foetal abuse registered in Catalonia between 2011 and 2014 to identify the risk profile. METHODS A cross-sectional descriptive study was conducted on a sample of 222 cases of prenatal abuse registered in Catalonia between 2011 and 2014. RESULTS The mean maternal age was 28.11 years, with 63% of Spanish nationality, 76% were unemployed, 60% had not followed correct gestational control, 76% had previous pregnancy interruptions, 20% reported to have been mistreated by the partner, had history of social problems (76% social intervention, 30.5% previous child retention, 13% custody of the mother by the administration, 7% deprivation of liberty), with high rates of mother-to-child transmission of infection (HIV 4.95%, HCV 9%, HIV+HCV co-infection 1.8%), and 73% reported toxic use (in order of frequency, cannabis, cocaine and heroin). In newborns, the rate of prematurity (26.3%) is highlighted, as well as the diagnosis of withdrawal syndrome in 34 cases. Just over half (51.6%) of the infants are currently with their mother. CONCLUSIONS In our reference population with a diagnosis of prenatal abuse, there are high rates of maternal toxic consumption, HIV-HCV infection, unemployment, history of previous social intervention, and poor gestational control.
Collapse
Affiliation(s)
- Jordi Garcia Garcia
- Servicio de Pediatría, Hospital del Mar, España; Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, España
| | | | - María Ángeles López-Vilchez
- Servicio de Pediatría, Hospital del Mar, España; Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, España.
| | | | - Antonio Mur Sierra
- Servicio de Pediatría, Hospital del Mar, España; Universitat Autònoma de Barcelona, Hospital del Mar, Barcelona, España
| |
Collapse
|
18
|
Garcia-Algar Ó, Cuadrado González A, Falcon M. Toxicology screening in paediatrics. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
19
|
Garcia-Algar Ó, Cuadrado González A, Falcon M. Utilidad del cribado toxicológico en pediatría. An Pediatr (Barc) 2016; 85:160.e1-4. [DOI: 10.1016/j.anpedi.2015.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022] Open
|
20
|
Maltrato prenatal. An Pediatr (Barc) 2016; 84:242. [DOI: 10.1016/j.anpedi.2015.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/13/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
|
21
|
Joya X, Marchei E, Salat-Batlle J, García-Algar O, Calvaresi V, Pacifici R, Pichini S. Drugs of abuse in maternal hair and paired neonatal meconium: an objective assessment of foetal exposure to gestational consumption. Drug Test Anal 2015; 8:864-8. [PMID: 26627903 DOI: 10.1002/dta.1921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/22/2015] [Accepted: 10/13/2015] [Indexed: 11/07/2022]
Abstract
In a prospective sample of 80 mother-infant dyads, we investigated whether drugs of abuse in maternal hair measured during the pregnancy trimesters were also present in neonatal meconium. Principal drugs of abuse were analyzed in the three consecutive maternal hair segments and meconium samples by ultra-performance liquid chromatography tandem mass spectrometry assay. Of the 80 mothers, 32 (40%) presented one or more hair shafts with at least one of the analyzed drugs of abuse and/or its metabolites. The drug of abuse with a higher prevalence in our study population was methamphetamine: 19 mothers had methamphetamine in one or more hair segments (59.4%). The second most detected drug of abuse was cocaine; nine mothers presented cocaine in one or more hair segments (28.1%). Nineteen pregnant women consumed at least one drug of abuse during the first trimester, ten continued consuming drugs of abuse during the second trimester; and nine consumed until the end of pregnancy. Five of the nine newborns from mothers who consumed drugs during the whole pregnancy showed drugs of abuse in meconium samples. Newborns from the 23 remaining mothers with one or two hair shafts positive to drugs of abuse did not present drugs in their meconium. Indeed from these results, it seems that discontinuous and/or sporadic consumption during pregnancy could produce a negligible transplacental passage and hence negative results in meconium. Furthermore, the role of placenta in the metabolism and excretion of drugs of abuse is still to be precisely investigated. Copyright © 2015 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Xavier Joya
- Unitat de Recerca Infància I Entorn (URIE), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Red de Salud Materno-Infantil y del Desarrollo (SAMID), Programa RETICS, Instituto Carlos III, Madrid, Spain
| | - Emilia Marchei
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanitá, Rome, Italy
| | - Judith Salat-Batlle
- Unitat de Recerca Infància I Entorn (URIE), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Red de Salud Materno-Infantil y del Desarrollo (SAMID), Programa RETICS, Instituto Carlos III, Madrid, Spain
| | - Oscar García-Algar
- Unitat de Recerca Infància I Entorn (URIE), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Red de Salud Materno-Infantil y del Desarrollo (SAMID), Programa RETICS, Instituto Carlos III, Madrid, Spain.,Departament de Pediatria, Obstetrícia i Ginecologia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - Valeria Calvaresi
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanitá, Rome, Italy
| | - Roberta Pacifici
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanitá, Rome, Italy
| | - Simona Pichini
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanitá, Rome, Italy
| |
Collapse
|
22
|
Maternal and neonatal hair and breast milk in the assessment of perinatal exposure to drugs of abuse. Bioanalysis 2015; 7:1273-97. [DOI: 10.4155/bio.15.60] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Perinatal exposure to one or more drugs of abuse can affect the neonate temporarily or permanently. In addition to meconium, the evaluation of perinatal exposure to drugs of abuse has been achieved by testing biological matrices coming from the newborn (neonatal hair) and from the pregnant or nursing mother (maternal hair and breast milk). These matrices have the advantage of noninvasive collection and account for a sizable time window of active and passive exposure. Sensitive and specific analytical methods are required to determine minute amounts of drugs of abuse and metabolites in these matrices. The present manuscript reviews the newest analytical methods developed to detect drugs of abuse as well as ethanol biomarkers in maternal and neonatal hair and breast milk.
Collapse
|
23
|
Mur Sierra A, Ortigosa Gómez S. ¿Es posible una nueva epidemia de consumo de heroína en España? Med Clin (Barc) 2014; 143:398-400. [DOI: 10.1016/j.medcli.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 11/29/2022]
|
24
|
Goettler SM, Tschudin S. Care of Drug-Addicted Pregnant Women: Current Concepts and Future Strategies – an Overview. WOMENS HEALTH 2014; 10:167-77. [DOI: 10.2217/whe.14.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review focuses on drug use during pregnancy and the perinatal period, a constellation that is seen more often. Drug use in pregnant women poses an increased risk for adverse health outcomes both for the mother and child. Care is often complicated by social and environmental factors, as well as psychiatric comorbidities. It is, therefore, very important to provide drug-using pregnant women with optimal ante-, peri- and post-natal care. Health professionals should approach them in a nonjudgmental and supportive way, and provide them with the same care and attention as nondrug-using women. Adequate care requires interdisciplinary teams. Ideally, healthcare providers should be specialized in the care of drug-using pregnant women.
Collapse
Affiliation(s)
- Simone M Goettler
- Department of Obstetrics & Gynecology, University Hospital Basel, Basel, Switzerland
| | - Sibil Tschudin
- Department of Obstetrics & Gynecology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
25
|
Assessment of unsuspected exposure to drugs of abuse in children from a Mediterranean city by hair testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2288-98. [PMID: 24566054 PMCID: PMC3945599 DOI: 10.3390/ijerph110202288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/12/2014] [Accepted: 02/13/2014] [Indexed: 11/17/2022]
Abstract
Hair testing was used to investigate the prevalence of unsuspected exposure to drugs of abuse in a group of children presenting to an urban paediatric emergency department without suggestive signs or symptoms. Hair samples were obtained from 114 children between 24 months and 10 years of age attending the emergency room of Hospital del Mar in Barcelona, Spain. Hair samples from the accompanying parent were also collected. The samples were analyzed for the presence of opiates, cocaine, amphetamines, and cannabinoids by ultra-performance liquid chromatography-tandem mass spectrometry. Parental sociodemographics and possible drug of abuse history were recorded. Hair samples from twenty-three children (20.1%) were positive for cocaine (concentration range 0.15–3.81 ng/mg hair), those of thirteen children (11.4%) to cannabinoids (Δ9-THC concentration range 0.05–0.54 ng/mg hair), with four samples positive to codeine (0.1–0.25 ng/mg hair), one positive for 2.09 ng methadone per mg hair and one to 6-MAM (0.42 ng/mg hair) and morphine (0. 15 ng/mg hair) . In 69.5 and 69.2% of the positive cocaine and cannabinoids cases respectively, drugs was also found in the hair of accompanying parent. Parental sociodemographics were not associated with children exposure to drugs of abuse. However, the behavioural patterns with potential harmful effects for the child’s health (e.g., tobacco smoking, cannabis, benzodiazepines and/or antidepressants use) were significantly higher in the parents of exposed children. In the light of the obtained results (28% overall children exposure to drugs of abuse) and in agreement with 2009 unsuspected 23% cocaine exposure in pre-school children from the same hospital, we support general hair screening to disclose exposure to drugs of abuse in children from risky environments to provide the basis for specific social and health interventions.
Collapse
|
26
|
Mozaner Bordin DC, Alves MNR, Cabrices OG, de Campos EG, De Martinis BS. A rapid assay for the simultaneous determination of nicotine, cocaine and metabolites in meconium using disposable pipette extraction and gas chromatography-mass spectrometry (GC-MS). J Anal Toxicol 2013; 38:31-8. [PMID: 24272386 DOI: 10.1093/jat/bkt092] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Drug abuse by pregnant women is considered a serious public health problem worldwide. Meconium is the first excretion in newborns and has been used as an alternative matrix to evaluate in utero drug exposure. Solid phase extraction (SPE) is widely employed to prepare and clean up samples in the field of forensic analysis. Most SPE products require large volumes of solvent, which culminates in longer sample processing times and increased cost per sample. Disposable pipette extraction (DPX) tips have been used as an alternative to traditional SPE cartridges. They combine efficient and rapid extraction with reduced solvent consumption. The purpose of this study was to develop and validate a method to determine nicotine, cotinine, cocaine, benzoylecgonine, cocaethylene and methyl ester anhydroecgonine in meconium using DPX and gas chromatography-mass spectrometry (GC-MS). Validation results indicated that extraction efficiency ranged 50-98%, accuracy 92-106%, intra-assay precision 4-12% and inter-assay precision 6-12%. Linear calibration curves resulted in R(2) values >0.99, limits of detection ranged from 2.5 to 15 ng/g and the limit of quantitation from 10 to 20 ng/g. The DPX-GC-MS method was shown to selectively analyze trace concentrations of drugs in meconium samples. Finally, the developed and validated method was applied to 50 meconium samples.
Collapse
Affiliation(s)
- Dayanne C Mozaner Bordin
- 1Departamento de Análises Clínicas, Toxicológicas e Bromatológicas, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP 14050-140, Brazil
| | | | | | | | | |
Collapse
|
27
|
García-Algar O, Mur Sierra A. [Exposure to drugs of abuse in paediatrics]. An Pediatr (Barc) 2013; 79:65-7. [PMID: 23809727 DOI: 10.1016/j.anpedi.2013.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022] Open
|
28
|
García-Serra J, Ramis J, Simó S, Joya X, Pichini S, Vall O, García-Algar O. [Alternative biological materials to detect prenatal exposure to drugs of abuse in the third trimester of pregnancy]. An Pediatr (Barc) 2012; 77:323-8. [PMID: 22513392 DOI: 10.1016/j.anpedi.2012.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION 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. PATIENTS AND METHODS 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. RESULTS 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. DISCUSSION 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.
Collapse
Affiliation(s)
- J García-Serra
- Servicio de Pediatría, Hospital de Can Misses, Ibiza, España
| | | | | | | | | | | | | |
Collapse
|
29
|
Puig C, Vall O, García-Algar O, Papaseit E, Pichini S, Saltó E, Villalbí JR. Assessment of prenatal exposure to tobacco smoke by cotinine in cord blood for the evaluation of smoking control policies in Spain. BMC Pregnancy Childbirth 2012; 12:26. [PMID: 22480136 PMCID: PMC3342916 DOI: 10.1186/1471-2393-12-26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 04/05/2012] [Indexed: 11/25/2022] Open
Abstract
Background Over the last few years a decreasing trend in smoking has occurred not only in the general population but also during pregnancy. Several countries have implemented laws requiring all enclosed workplace and public places to be free of second hand smoke (SHS). In Spain, legislation to reduce SHS was implemented in 2005. The present study examines the possible effect of this legislation on prenatal SHS exposure. Methods Mothers and newborns were recruited from 3 independent studies performed in Hospital del Mar (Barcelona) and approved by the local Ethics Committee: 415 participated in a study in 1996-1998, 283 in 2002-2004 and 207 in 2008. A standard questionnaire, including neonatal and sociodemographic variables,tobacco use and exposure during pregnancy, was completed at delivery for all the participants in the three study groups. Fetal exposure to tobacco was studied by measuring cotinine in cord blood by radioimmunoassay (RIA). Results 32.8% of the pregnant women reported to smoke during pregnancy in 1996-1998, 25.9% in 2002-2004 and 34.1% in 2008. In the most recent group, the percentage of no prenatal SHS exposure (cord blood cotinine 0.2-1 ng/mL) showed an increase compared to the previous groups while the percentages of both: low (1.1-14 ng/mL) and very high (> 100 ng/mL) prenatal SHS exposure showed a decrease. Discussion The results of the three study periods (1996-2008) demonstrated a significant increase in the percentage of newborns free from SHS exposure and a decrease in the percentage of newborns exposed to SHS during pregnancy, especially at the very high levels of exposure. A significant maternal smoking habit was noted in this geographical area with particular emphasis on immigrant pregnant smoking women. Conclusions Our study indicates that there is a significant maternal smoking habit in this geographical area. Our recommendation is that campaigns against smoking should be directed more specifically towards pregnant women with particular emphasis on non-native pregnant smokers due to the highest prevalence of tobacco consumption in the immigrant women.
Collapse
Affiliation(s)
- Carme Puig
- Institut Municipal d'Investigacions Mèdiques, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
30
|
Ortega-García JA, Gutierrez-Churango JE, Sánchez-Sauco MF, Martínez-Aroca M, Delgado-Marín JL, Sánchez-Solis M, Parrilla-Paricio JJ, Claudio L, Martínez-Lage JF. Head circumference at birth and exposure to tobacco, alcohol and illegal drugs during early pregnancy. Childs Nerv Syst 2012; 28:433-9. [PMID: 22002105 PMCID: PMC5240472 DOI: 10.1007/s00381-011-1607-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 09/28/2011] [Indexed: 10/17/2022]
Abstract
AIMS We aimed to assess the effects of exposure to tobacco smoke, alcohol and illegal drugs during early pregnancy on the head circumference (HC) at birth of otherwise healthy neonates. METHODS A follow-up study from the first trimester of pregnancy to birth was carried out in 419 neonates. An environmental reproductive health form was used to record data of substance exposure obtained during the first obstetric visit at the end of the first trimester. A multiple linear regression model was created for this purpose. RESULTS Alcohol intake during pregnancy and medical ionizing radiation exposure were the most significant predictors of HC. The mothers' alcohol consumption increased with the mothers' and fathers' education level, net family income and fathers' alcohol consumption. In contrast, maternal smoking decreased with increasing mothers' and fathers' education level and net family income. About 13% of the surveyed embryos were exposed to illegal drugs. CONCLUSIONS Mild to moderate alcohol consumption diminishes the at-birth HC of theoretically healthy newborns in a linear form. There was no threshold dose. We perceived a need for increasing the awareness, and for training, of health care professionals and parents, in regard to risks of alcohol consumption and for recommending abstinence of these substances in both parents during pregnancy. It should also be remembered that medical ionizing radiation should be performed only during the first half of the cycle in fertile women. We think that our study has an important social impact as it affords data for implementing policies for promoting "healthy pregnancies".
Collapse
Affiliation(s)
- Juan A. Ortega-García
- Pediatric Environmental Health Specialty Unit, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain, www.pehsu.org
| | - Jorge E. Gutierrez-Churango
- Pediatric Environmental Health Specialty Unit, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| | - Miguel F. Sánchez-Sauco
- Pediatric Environmental Health Specialty Unit, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| | - Miguel Martínez-Aroca
- Pediatric Environmental Health Specialty Unit, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| | - Juan L. Delgado-Marín
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| | - M. Sánchez-Solis
- Department of Pediatric, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| | - J. J. Parrilla-Paricio
- Department of Obstetrics and Gynecology, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| | - Luz Claudio
- Department of Community Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Juan F. Martínez-Lage
- Regional Service of Neurosurgery, Grupo de Investigación en Neurocirugía (GRIN), Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
[Validity of a maternal alcohol consumption questionnaire in detecting prenatal exposure]. An Pediatr (Barc) 2011; 76:324-8. [PMID: 22104595 DOI: 10.1016/j.anpedi.2011.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/09/2011] [Accepted: 09/14/2011] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Ethanol consumption by pregnant women can produce severe effects in the foetus and the newborn, mainly in neurological and weight-height development, and are included in the term FASD (Fetal Alcohol Spectrum Disorder). Questionnaires are the most used screening method to detect prenatal exposure, but a previous population study questioned its reliability. The objective of this study was to compare alcohol prenatal exposure detection by questionnaire compared with biomarkers in meconium. METHODOLOGY Sixty two meconium samples from mothers who denied alcohol consumption during pregnancy by questionnaire were analysed. The objective analysis was made by determination of FAEEs (fatty acid ethyl esters) as exposure biomarkers in meconium as biological matrix. RESULTS In the meconium from 10 of 62 newborns from non-alcohol consuming mothers by questionnaire (16.12%) FAEE values were positive (≥ 2 nmol/g). DISCUSSION Questionnaires as a screening method during pregnancy are not a reliable tool. It is necessary to identify prenatal exposure to alcohol as soon as possible by biomarkers analysis in biological matrices from the newborn or the mother. The early detection will allow these patients to benefit from follow up and treatment to reach the best possible neurological development.
Collapse
|
33
|
Joya X, Fríguls B, Simó M, Civit E, de la Torre R, Palomeque A, Vall O, Pichini S, Garcia-Algar O. Acute heroin intoxication in a baby chronically exposed to cocaine and heroin: a case report. J Med Case Rep 2011; 5:288. [PMID: 21729296 PMCID: PMC3141724 DOI: 10.1186/1752-1947-5-288] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 07/05/2011] [Indexed: 12/03/2022] Open
Abstract
Introduction Acute intoxication with drugs of abuse in children is often only the tip of the iceberg, actually hiding chronic exposure. Analysis using non-conventional matrices such as hair can provide long-term information about exposure to recreational drugs. Case presentation We report the case of a one-month-old Caucasian boy admitted to our pediatric emergency unit with respiratory distress and neurological abnormalities. A routine urine test was positive for opiates, suggesting an acute opiate ingestion. No other drugs of misuse, such as cocaine, cannabis, amphetamines or derivatives, were detected in the baby's urine. Subsequently, hair samples from the baby and the parents were collected to evaluate the possibility of chronic exposure to drug misuse by segmental analysis. Opiates and cocaine metabolites were detected in hair samples from the baby boy and his parents. Conclusions In light of these and previous results, we recommend hair analysis in babies and children from risky environments to detect exposure to heroin and other drug misuse, which could provide the basis for specific social and health interventions.
Collapse
Affiliation(s)
- Xavier Joya
- Unitat de Recerca Infancia i Entorn (URIE), Institut Municipal d'Investigació Mèdica (IMIM)-Hospital del Mar, Barcelona, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Ortigosa Gómez S, López-Vilchez MA, Díaz Ledo F, Castejón Ponce E, Caballero Rabasco A, Carreras Collado R, Mur Sierra A. Consumo de drogas durante la gestación y su repercusión neonatal. Análisis de los períodos 1982-1988 y 2002-2008. Med Clin (Barc) 2011; 136:423-30. [DOI: 10.1016/j.medcli.2010.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/31/2010] [Accepted: 06/01/2010] [Indexed: 11/26/2022]
|
35
|
García-Algar O, Gómez A. Cannabis en urgencias de pediatría. An Pediatr (Barc) 2010; 72:375-6. [DOI: 10.1016/j.anpedi.2010.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 04/14/2010] [Indexed: 12/01/2022] Open
|
36
|
Guillén JMB, Company ES. Use of antipsychotics during pregnancy and breastfeeding. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2009; 2:138-45. [PMID: 23034313 DOI: 10.1016/s1888-9891(09)72405-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 04/28/2009] [Indexed: 12/21/2022]
Abstract
There is growing acceptance that pregnancy itself is not a protective factor against mental disorders. Indeed, some mental disorders such as psychotic and bipolar disorders may become worse during pregnancy and the immediate postpartum period. In pregnant women with a mental disorder that can be treated with antipsychotics, the known risks -teratogenic, obstetric, neonatal and those affecting the mother- indicate that, in general, the risk of the non-treated disorder is higher than that resulting from the use of antipsychotics and that the reduction in psychoticism improves the overall prognosis of these women. All the antipsychotics marketed in Spain are included in category C of the US Food and Drug Administration, with the exception of clozapine and piperazine, which are included in category B. The use of all of these drugs should be avoided during breast feeding as far as possible. The most reliable current recommendations indicate that optimal control of severe mental disorders should be maintained during pregnancy, the postpartum and subsequent periods. These recommendations also indicate that women with mental disorders must be considered as high risk and that both these women and their pregnancies should be constantly monitored. The currently available scientific information does not allow more than relatively secure individually-tailored recommendations to be made. When taking the decision of whether or not to treat with antipsychotics, the use of a risk-benefit relationship is crucial, with the participation of the woman's partner or legal representative, other physicians and even the clinical pharmacist if necessary.
Collapse
Affiliation(s)
- José Manuel Bertolín Guillén
- Unidad de Hospitalización Psiquiátrica, Servicio de Psiquiatría, Departamento de Salud Valencia-Arnau de Vilanova, Agència Valenciana de Salut, Valencia, España.
| | | |
Collapse
|