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Barenys M, Álvarez S, Santamaria A, Teixidó E, Gómez-Catalán J. Developmental exposure to MDMA (ecstasy) in zebrafish embryos reproduces the neurotoxicity adverse outcome 'lower motor activity' described in humans. Neurotoxicology 2021; 88:116-123. [PMID: 34763029 DOI: 10.1016/j.neuro.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
The recreational use of MDMA (ecstasy) by pregnant women is associated with impaired neuromotor function in infants, but the Adverse Outcome Pathway behind this effect is not clear yet. We present for the first time the evaluation of developmental neurotoxic (DNT) effects of MDMA in zebrafish embryos. The aim of the study was to determine whether the zebrafish model reproduces the adverse outcome occurring in humans. We have studied the DNT effects of MDMA in zebrafish within a range of 5-250 μM performing different behavioural tests: spontaneous tail-coiling and light-dark locomotor response; after exposing the embryos to 4 different scenarios combining changes in pH, in starting exposure time and exposure duration. In these scenarios we evaluated the effects of MDMA in general embryonic development and compared the concentrations producing them with those inducing specific DNT effects. As a result, we have established the experimental conditions leading to the adverse outcome "lower motor activity" in zebrafish without producing general developmental delay or general toxicity. The experimental condition chosen opens the door to use this model in future mechanistic investigations to better characterize the Adverse Outcome Pathway associated with the adverse effects caused by MDMA prenatal exposure in humans.
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Affiliation(s)
- Marta Barenys
- GRET, INSA-UB and Toxicology Unit, Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain.
| | - Shami Álvarez
- GRET, INSA-UB and Toxicology Unit, Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Ariadna Santamaria
- GRET, INSA-UB and Toxicology Unit, Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Elisabet Teixidó
- GRET, INSA-UB and Toxicology Unit, Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
| | - Jesús Gómez-Catalán
- GRET, INSA-UB and Toxicology Unit, Department of Pharmacology, Toxicology and Therapeutic Chemistry, Faculty of Pharmacy and Food Sciences, University of Barcelona, Barcelona, Spain
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2
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Rotolo MC, Pacifici R, Pellegrini M, Cardullo S, Pérez LJG, Cuppone D, Gallimberti L, Madeo G. Hair Testing for Classic Drugs of Abuse to Monitor Cocaine Use Disorder in Patients Following Transcranial Magnetic Stimulation Protocol Treatment. Biology (Basel) 2021; 10:403. [PMID: 34062953 DOI: 10.3390/biology10050403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Abstract
Simple Summary Hair testing for classic drugs of abuse offers the possibility of longer detection times (for drug substances) when compared to urine analysis. Hair analysis is routinely used to detect drug abuse in forensic cases and clinical toxicology, whereas it is rarely used at addiction clinics to monitor the clinical efficacy of therapeutic interventions. Here, we explore for the first time whether hair analysis might represent a valid tool to track the clinical improvements in a population of patients with cocaine use disorder (CocUD) who underwent a repetitive transcranial magnetic stimulation (rTMS) treatment. Abstract In recent years, hair has become an alternative biological specimen for drug testing in the fields of forensic and clinical toxicology. The advantages of hair testing include larger detection windows (months/years), depending on the length of the hair shaft, compared to those of urine/blood (hours to 2–4 days for most drugs). Segmental hair analysis can disclose a month-to-month (considering 1 cm segment cuts) information of drug exposure (single or repeated) and potentially identify patterns of drug use/administration. Repetitive transcranial magnetic stimulation (rTMS) was recently proposed as a valid tool for therapeutic purposes in addictions, including cocaine use disorder (CocUD). Here, we proposed hair testing analyses of classic drugs of abuse in a clinical setting to monitor the clinical changes in treatment-seeker CocUD patients undergoing protocol treatments with rTMS stimulating the left dorsolateral prefrontal cortex (l-DLPFC). We collected hair samples from nine CocUD patients at different stages from the beginning of treatments. Hair sample analyses revealed significant changes in the patterns of cocaine use, according to the negativity of urine screening tests and the clinical reductions of craving. These data, albeit preliminary, suggest that hair testing analysis of classic drugs of abuse could be extended to clinical settings to monitor the clinical efficacy of innovative therapeutic interventions, such as rTMS.
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Yermachenko A, Massari V, Azria E, Clergue-Duval V, Thurn M, El-Khoury Lesueur F, Jauffret-Roustide M, Melchior M. Unintended pregnancy prevention in women using psychoactive substances: A systematic review. Addict Behav 2020; 107:106393. [PMID: 32200197 DOI: 10.1016/j.addbeh.2020.106393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
This systematic review seeks to evaluate the efficacy of interventions aimed at preventing unintended pregnancies in women using psychoactive substances. Seven electronic databases (Medline, EMBASE, CINAHL, Web of Science Core Collection, PsycINFO, Cochrane CENTRAL database) were searched in October 2017. Twenty-two articles met our inclusion criteria. Interventions based on behavior change theory yielded an increase in the initiation of effective contraception as compared with provision of written information materials. The effect was more pronounced when the intervention provided on-site contraceptive counseling and free access to birth control. Financial incentives also seemed to effectively increase women's contraception intake. Case management interventions including pregnant and postpartum women with heavy levels of substance use showed promising results in terms of initiation of contraception, but rates of unintended pregnancy over long-term follow-up were nevertheless elevated. Finally, some interventions integrated family planning services into specialized centers taking care of pregnant and postpartum women with substance abuse. However, most studies aimed at postpartum and post-abortion contraception used a non-comparative design and had a number of methodological flaws. The risk of bias in most studies is high. All interventions with a primary or secondary focus on the prevention of unintended pregnancy in women using psychoactive substances short-term improvements in contraception intake, but it is unclear if these effects last or have any impact on unintended pregnancy rates in the long-term.
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Affiliation(s)
- Anna Yermachenko
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | - Véronique Massari
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | - Elie Azria
- Université Sorbonne Paris Cité, INSERM, UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPe research team), DHU Risks in Pregnancy, Paris, France; Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Virgile Clergue-Duval
- APHP, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, 200 rue du Faubourg Saint-Denis, 75010 Paris, France; Université Sorbonne Paris Cité, Faculté de Médecine, Paris Diderot, Paris, France
| | - Marion Thurn
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France; Cermes 3 (Inserm U988/CNRS UMR 8211/EHESS/Université Paris Descartes), Paris, France
| | - Fabienne El-Khoury Lesueur
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France
| | | | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, ERES, 75012 Paris, France.
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Martin R, Bruxner G, Ng G, Brewster C, Kothari A. Drowning our sorrows: clinical and ethical considerations of termination in alcohol-affected pregnancy. BMC Pregnancy Childbirth 2020; 20:356. [PMID: 32522252 PMCID: PMC7288674 DOI: 10.1186/s12884-020-03012-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Roger Martin
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia.,Department of Obstetrics & Gynaecology, Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia
| | - George Bruxner
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia.,Metro North Mental Health Service, Herston, 4029, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, 4067, Queensland, Australia
| | - Gary Ng
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia.,Department of Obstetrics & Gynaecology, Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia
| | - Catherine Brewster
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia.,Department of Alcohol & Other Drugs, Redcliffe Hospital, Redcliffe, 4020, Queensland, Australia
| | - Alka Kothari
- Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia. .,Department of Obstetrics & Gynaecology, Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia. .,Faculty of Medicine, The University of Queensland, St Lucia, 4067, Queensland, Australia.
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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7
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Taft AJ, Powell RL, Watson LF, Lucke JC, Mazza D, McNamee K. Factors associated with induced abortion over time: secondary data analysis of five waves of the Australian Longitudinal Study on Women's Health. Aust N Z J Public Health 2019; 43:137-142. [PMID: 30727034 DOI: 10.1111/1753-6405.12874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/01/2018] [Accepted: 12/01/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE A trend analysis of associations with induced abortion. METHODS Secondary analysis of the 1973/78 cohort of the Australian Longitudinal Study of Women's Health of women responding to two or more consecutive surveys out of five (N=9,042), using generalised estimating equations. RESULTS New abortions dropped from 7% to 2% at surveys 4 and 5. By survey 5, 16% of respondents reported abortions, only 2% of them new. Women aged in their twenties were more likely to terminate a pregnancy if they reported less-effective contraceptives (aOR2.18 CI 1.65-2.89); increased risky drinking (aOR1.65 CI 1.14-2.38); illicit drugs ≤12 months (aOR3.09 CI 2.28-4.19); or recent partner violence (aOR2.42 CI 1.61-3.64). By their thirties, women were more likely to terminate if they reported violence (aOR2.16 CI 1.31-3.56) or illicit drugs <12 months (aOR2.69 CI 1.77-4.09). Women aspiring to be fully- (OR1.58 CI 1.37-1.83) or self-employed (OR1.28 CI 1.04-1.57), with no children (OR1.41 CI 1.14-1.75) or further educated (OR 2.08 CI 1.68-2.57) were more likely to terminate than other women. CONCLUSIONS Abortion remains strongly associated with factors affecting women's control over reproductive health such as partner violence and illicit drug use. Implications for public health: Healthcare providers should inquire about partner violence and illicit drug use among women seeking abortion, support women experiencing harm and promote effective contraception.
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Affiliation(s)
| | | | | | - Jayne C Lucke
- Australian Research Centre in Sex, Health and Society, La Trobe University, Victoria.,School of Public Health, University of Queensland
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Victoria
| | - Kathleen McNamee
- Department of Obstetrics and Gynaecology, Monash Health, Victoria
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Paniagua-González L, Jiménez-Morigosa C, Lendoiro E, Concheiro M, Cruz A, López-Rivadulla M, de Castro A. Development and validation of a liquid chromatography-tandem mass spectrometry method for the determination of nicotine and its metabolites in placenta and umbilical cord. Drug Test Anal 2018; 10:1305-1314. [PMID: 29524345 DOI: 10.1002/dta.2381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/11/2022]
Abstract
Tobacco exposure during pregnancy is associated with obstetric and fetal complications. We developed and validated a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to determine nicotine, cotinine, and hydroxycotinine (OH-cotinine) in placenta (PL) and umbilical cord (UC). Specimens were homogenized in water, followed by solid-phase extraction. Chromatographic separation was performed using an Atlantis® HILIC Silica column. Detection was accomplished in electrospray in positive mode. Method validation included: linearity (5 to 1000 ng/g), accuracy (86.9 to 105.2% of target concentration in PL, and 89.1 to 105.0% in UC), imprecision (6.8 to 11.8% in PL, and 7.6 to 12.2% in UC), limits of detection (2 ng/g for cotinine and OH-cotinine, and 5 ng/g for nicotine) and quantification (5 ng/g), selectivity (no endogenous or exogenous interferences), matrix effect (-34.1 to -84.5% in PL, %CV = 9.1-24.0%; -18.9 to -84.7% in UC, %CV = 10.2-23.9%), extraction efficiency (60.7 to 131.5% in PL, and 64.1 to 134.2% in UC), and stability 72 h in the autosampler (<11.5% loss in PL, and < 13% loss in UC). The method was applied to 14 PL and UC specimens from tobacco users during pregnancy. Cotinine (6.8-312.2 ng/g in PL; 6.7-342.3 ng/g in UC) was the predominant analyte, followed by OH-cotinine (
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Affiliation(s)
- Lucía Paniagua-González
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristian Jiménez-Morigosa
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Elena Lendoiro
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
- School of Pharmacy and Life Sciences, The Robert Gordon University, Aberdeen, UK
| | - Marta Concheiro
- Department of Sciences, John Jay College of Criminal Justice, City University of New York, New York
| | - Angelines Cruz
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel López-Rivadulla
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana de Castro
- Toxicology Service, Institute of Forensic Sciences, University of Santiago de Compostela, Santiago de Compostela, Spain
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Lamy S, Hennart B, Houivet E, Dulaurent S, Delavenne H, Benichou J, Allorge D, Marret S, Thibaut F. Assessment of tobacco, alcohol and cannabinoid metabolites in 645 meconium samples of newborns compared to maternal self-reports. J Psychiatr Res 2017; 90:86-93. [PMID: 28237885 DOI: 10.1016/j.jpsychires.2017.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/28/2023]
Abstract
Prenatal psychoactive substance exposure has significant impact on neonatal health and child development and the development of reliable biomarkers is critical. Meconium presents several advantages for detecting prenatal exposure to psychoactive substances, as it is easy to collect and provides a broad time frame of exposure (third trimester). The aim of our study was to compare the prevalence of alcohol, tobacco and/or cannabis use during the third trimester of pregnancy (using maternal self-reports) with the results of meconium testing of their metabolites in newborns (cotinine, ethyl-glucuronide (EtG) and cannabinoid metabolites). Among all deliveries (993) that occurred in all maternities in Rouen (Normandy) during a defined time period (5 consecutive weeks in August, 2010 and August, 2011), 724 mothers were included and 645 meconium samples were collected. Maternal self-reports, using the Addiction Severity Index (5th edition), and meconium samples were collected within 72 h of delivery. Cotinine detection appears highly correlated to maternal self-reports (Kappa value: 0.79; [95%CI: 0.73-0.85]). Moreover, detection in meconium seems more accurate in the prediction of neonatal consequences of prenatal tobacco exposure as compared to maternal self-reports. In contrast, we have found a lower concordance between maternal self-reports and meconium testing for EtG and cannabinoid metabolites (Kappa value: 0.13; [95%CI: 0.04-0.22] and: 0.30; [95%CI: -0.03-0.63], respectively); however the total number of EtG- and cannabinoid-positive meconium samples was small. Interestingly, meconium samples with the highest levels of EtG mainly corresponded to negative maternal self-reports. Fetal exposure to alcohol, tobacco or cannabis may also considerably differ as displayed in our pairs of dizygotic twins. Finally, a polyconsumption of these psychoactive substances was not frequently observed according to meconium testing. In conclusion, cotinine detection appears as a valuable meconium biomarker. EtG measurement in meconium samples seems interesting if there is any risk of high fetal exposure, whereas assessment of prenatal cannabis exposure, using meconium testing, needs to be improved.
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Affiliation(s)
- Sandrine Lamy
- Department of Addictology, Ramsay- General de Santé, SSR Petit Colmoulins, Harfleur, France; University Hospital Cochin (site Tarnier), University Sorbonne Paris-Cité (Paris V), Faculty of Medicine Paris Descartes, INSERM U894, Centre Psychiatry and Neurosciences, Paris, France.
| | - Benjamin Hennart
- CHU Lille, Service de Toxicologie-Génopathies, F-59000 Lille, France.
| | - Estelle Houivet
- Department of Biostatistics, University Hospital Rouen, Centre d'Investigation Clinique et de Ressources Biologiques, INSERM CIC-CRB, 1404 Rouen, France.
| | - Sylvain Dulaurent
- Laboratoire de Pharmacologie, Toxicologie et Pharmacovigilance, Hôpital Dupuytren, CHU de Limoges, France.
| | - Heloise Delavenne
- Department of Psychiatry, Faculty of Medicine, Federal University of Minas Gerais, Brazil.
| | - Jacques Benichou
- Department of Biostatistics, University Hospital Rouen, Centre d'Investigation Clinique et de Ressources Biologiques, INSERM CIC-CRB, 1404 Rouen, France.
| | - Delphine Allorge
- CHU Lille, Service de Toxicologie-Génopathies, F-59000 Lille, France; Univ.Lille, EA 4483-IMPECS- IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France.
| | - Stéphane Marret
- Department of Neonatal Medicine-Neuropediatrics, Rouen University Hospital and INSERM U 1245, Neovasc Team, Perinatal neurological handicap and Neuroprotection, Institute of Biomedical Research and Innovation, School of Medicine, Normandy University, France.
| | - Florence Thibaut
- University Hospital Cochin (site Tarnier), University Sorbonne Paris-Cité (Paris V), Faculty of Medicine Paris Descartes, INSERM U894, Centre Psychiatry and Neurosciences, Paris, France.
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Prego-meleiro P, Lendoiro E, Concheiro M, Cruz A, López-rivadulla M, de Castro A. Development and validation of a liquid chromatography tandem mass spectrometry method for the determination of cannabinoids and phase I and II metabolites in meconium. J Chromatogr A 2017; 1497:118-26. [DOI: 10.1016/j.chroma.2017.03.066] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/24/2022]
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Płotka J, Narkowicz S, Polkowska Z, Biziuk M, Namieśnik J. Effects of addictive substances during pregnancy and infancy and their analysis in biological materials. Rev Environ Contam Toxicol 2014; 227:55-77. [PMID: 24158579 DOI: 10.1007/978-3-319-01327-5_2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of addictive substances during pregnancy is a serious social problem, not only because of effects on the health of the woman and child, but also because drug or alcohol dependency detracts from child care and enhances the prospect of child neglect and family breakdown. Developing additive substance abuse treatment programs for pregnant women is socially important and can help ensure the health of babies, prevent subsequent developmental and behavioral problems (i.e., from intake of alcohol or other additive substances such as methamphetamine, cocaine,or heroine) and can reduce addiction costs to society. Because women of childbearing age often abuse controlled substances during their pregnancy, it is important to undertake biomonitoring of these substances in biological samples taken from the pregnant or nursing mother (e.g., blood, urine,hair, breast milk, sweat, oral fluids, etc.), from the fetus and newborn (e.g., meconium,cord blood, neonatal hair and urine) and from both the mother and fetus (i.e.,amniotic fluids and placenta). The choice of specimens to be analyzed is determined by many factors; however, the most important is knowledge of the chemical and physical characteristics of a substance and the route of it administration. Maternal and neonatal biological materials reflect exposures that occur over a specific time period, and each of these biological specimens has different advantages and disadvantages,in terms of accuracy, time window of exposure and cost/benefit ratio.Sampling the placenta may be the most important biomonitoring choice for assessing in utero exposure to addictive substances. The use of the placenta in scientific research causes a minimum of ethical problems, partly because its sampling is noninvasive, causes no harm to mother or child, and partly because, in any case,placentas are discarded and incinerated after birth. Such samples, when properly analyzed, may provide key essential information about fetal exposure to toxic substances, and may provide the groundwork for protecting the fetus or newborn and the mother from further damage.Several sensitive and specific bioanalytical methods are commonly utilized to accurately measure for drug biomarkers of in utero drug exposure. Moreover, several immunoassay methods are used to rapidly screen for drugs in many biological specimen types. However, results from immunoassays should be carefully interpreted,and should be confirmed by more specific and sensitive chromatographic methods, such as GC-MS or LC-MS. Although techniques for analysis of addictive substances are still being developed or are being refined, current methods are efficient and sensitive and provide valuable information on human exposures to addictive substances and their metabolites.
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Affiliation(s)
- Justyna Płotka
- Department of Analytical Chemistry, Chemical Faculty, Gdansk University of Technology (GUT), 11/12 Narutowicza Street, 80-233, Gdańsk, Poland,
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Lendoiro E, González-Colmenero E, Concheiro-Guisán A, de Castro A, Cruz A, López-Rivadulla M, Concheiro M. Maternal Hair Analysis for the Detection of Illicit Drugs, Medicines, and Alcohol Exposure During Pregnancy. Ther Drug Monit 2013; 35:296-304. [DOI: 10.1097/ftd.0b013e318288453f] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
AIMS Concern about the effects of alcohol and drug use during pregnancy is intertwined with debates about abortion. There is concern that alcohol abstinence recommendations lead women using low levels of alcohol to terminate otherwise wanted pregnancies. This study examines how women describe alcohol, tobacco and/or drug use (ATOD) as reasons for deciding to have abortions and assesses the differences between women reporting and not reporting ATOD as reasons for deciding to have an abortion. METHODS Data come from the UCSF Turnaway Study which recruited 956 women seeking an abortion at one of 30 US clinics between 2008 and 2010. Mixed methods were used and data were analyzed through thematic coding and logistic regression. RESULTS Nearly 5% reported ATOD as a reason for abortion. Women worried that their ATOD had affected their baby's health and that their or their partner's ATOD would influence parenting. Most women (84%) who reported alcohol as a reason binge drank or had an alcohol-problem symptom in the month before discovering their pregnancy. Sixty-one percent who reported drugs as a reason used drugs, with 88% using more than once/week. Although two-thirds smoked tobacco, no woman reported tobacco alone as a reason. Ninety-eight percent of women reporting ATOD as a reason had unintended pregnancies. CONCLUSION Women reporting ATOD as a reason drink at levels exceeding a low threshold and do not appear to be terminating otherwise wanted pregnancies. Thus, findings are inconsistent with hypotheses that abstinence recommendations and punitive policies lead women using low levels of alcohol or using drugs to terminate otherwise wanted pregnancies.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA 94612, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- J García-Serra
- Servicio de Pediatría, Hospital de Can Misses, Ibiza, España
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16
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Joya X, Gomez-Culebras M, Callejón A, Friguls B, Puig C, Ortigosa S, Morini L, Garcia-Algar O, Vall O. Cocaine use during pregnancy assessed by hair analysis in a Canary Islands cohort. BMC Pregnancy Childbirth 2012; 12:2. [PMID: 22230295 PMCID: PMC3277455 DOI: 10.1186/1471-2393-12-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 01/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug use during pregnancy is difficult to ascertain, and maternal reports are likely to be inaccurate. The aim of this study was to estimate the prevalence of illicit drug use among pregnant women by using maternal hair analysis. METHODS A toxicological analysis of hair was used to detect chronic recreational drug use during pregnancy. In 2007, 347 mother-infant dyads were included from the Hospital La Candelaria, Santa Cruz de Tenerife, Canary Islands (Spain). Data on socioeconomic characteristics and on substance misuse during pregnancy were collected using a structured questionnaire. Drugs of abuse: opiates, cocaine, cannabinoids and amphetamines were detected in maternal hair by immunoassay followed by gas chromatography-mass spectrometry for confirmation and quantitation. RESULTS Hair analysis revealed 2.6% positivity for cocaine and its metabolites. Use of cocaine during pregnancy was associated with unusual behaviour with potentially harmful effects on the baby. CONCLUSIONS The results of the study demonstrate significant cocaine use by pregnant women in Canary Islands. The data should be used for the purpose of preventive health and policy strategies aimed to detect and possibly to avoid in the future prenatal exposure to drugs of abuse.
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Affiliation(s)
- Xavier Joya
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
| | | | - Alicia Callejón
- Departamento de Cirugía Pediátrica, Universidad de Tenerife, Spain
| | - Bibiana Friguls
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Carme Puig
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
| | - Sandra Ortigosa
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Luca Morini
- Department of Legal Medicine and Public Health, University of Pavia, Italy
| | - Oscar Garcia-Algar
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oriol Vall
- Unitat de Recerca Infància i Entorn (URIE), Institut de Recerca Parc de Salut Mar (IMIM-Parc de Salut Mar), Barcelona, Spain
- Red de Salud Materno-Infantil y del Desarrollo (SAMID
- Programa RETIC, Instituto Carlos III (ISCIII), Madrid, Spain
- Servei de Pediatria, Parc de Salut Mar, Barcelona, Spain
- Departament de Pediatria, Ginecologia i Obstetrícia i Medicina Preventiva, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Pichini S, Marchei E, Vagnarelli F, Tarani L, Raimondi F, Maffucci R, Sacher B, Bisceglia M, Rapisardi G, Elicio MR, Biban P, Zuccaro P, Pacifici R, Pierantozzi A, Morini L. Assessment of prenatal exposure to ethanol by meconium analysis: results of an Italian multicenter study. Alcohol Clin Exp Res 2011; 36:417-24. [PMID: 22168178 DOI: 10.1111/j.1530-0277.2011.01647.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study estimated in 7 Italian cities the prevalence of prenatal exposure to ethanol by determining fatty acid ethyl esters (FAEEs; palmitic, palmitoleic, stearic, oleic, linoleic, linolenic, and arachidonic esters) and ethyl glucuronide (EtG) in neonatal meconium samples. METHODS A total of 607 meconium samples were obtained from neonatal wards of 7 public hospitals: Verona and San Daniele del Friuli in the northeast of the country, Reggio Emilia in the middle east, Florence and Rome in the center, and Naples and Crotone in the southwest of the peninsula. Meconium biomarkers were assessed by a validated methodology using liquid chromatography-tandem mass spectrometry and the results categorized using the accepted cutoff of 2 nmol/g total amount of 7 FAEEs and 2 nmol/g EtG, to differentiate between heavy maternal ethanol use during pregnancy and occasional or no use at all. RESULTS On the basis of the above-reported cutoffs, the overall prevalence of newborns prenatally exposed to maternal ethanol was 7.9%: 0% in Verona, 4.0% in San Daniele del Friuli, 4.9% in Naples, 5.0% in Florence, 6.2% in Crotone, up to 10.6% in Reggio Emilia, and 29.4% in Rome. Low maternal education level and younger maternal age were associated with biomarker scores over the cutoff. There was also a significant correlation between the highest percentage of prenatal exposure in the capital and certain maternal sociodemographic characteristics. CONCLUSIONS These results indicate considerable variability in the prevalence of fetal exposure to ethanol in different Italian cities, as determined by the objective measurement of biomarkers in meconium. These data, together with previous ones obtained in Barcelona, Spain, indicate that gestational ethanol exposure is widespread, at least in parts of Europe.
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Barroso M, Gallardo E, Vieira DN, Queiroz JA, López-Rivadulla M. Bioanalytical procedures and recent developments in the determination of opiates/opioids in human biological samples. Anal Bioanal Chem 2011; 400:1665-90. [PMID: 21442365 DOI: 10.1007/s00216-011-4888-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 03/06/2011] [Accepted: 03/08/2011] [Indexed: 12/27/2022]
Abstract
The use and abuse of illegal drugs affects all modern societies, and therefore the assessment of drug exposure is an important task that needs to be accomplished. For this reason, the reliable determination of these drugs and their metabolites in biological specimens is an issue of utmost relevance for both clinical and forensic toxicology laboratories in their fields of expertise, including in utero drug exposure, driving under the influence of drugs and drug use in workplace scenarios. Most of the confirmatory analyses for abused drugs in biological samples are performed by gas chromatographic-mass spectrometric methods, but use of the more recent and sensitive liquid chromatography-(tandem) mass spectrometry technology is increasing dramatically. This article reviews recently published articles that describe procedures for the detection of opiates in the most commonly used human biological matrices, blood and urine, and also in unconventional ones, e.g. oral fluid, hair, and meconium. Special attention will be paid to sample preparation and chromatographic analysis.
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Affiliation(s)
- M Barroso
- Instituto Nacional de Medicina Legal-Delegação do Sul, Rua Manuel Bento de Sousa, 3, 1150-219 Lisboa, Portugal.
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Current Awareness in Drug Testing and Analysis. Drug Test Anal 2010; 2:507-22. [DOI: 10.1002/dta.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Illicit substance use is not uncommon in women of childbearing age. The direct effects of illicit substance use on the mother, pregnancy and the fetus are not well understood, in contrast to the indirect effects of social disadvantage and intercurrent medical and psychiatric illness, which are well documented. We have undertaken a review of the current literature regarding the effects of illicit substance use in pregnancy and include a suggested approach to identification and management of at-risk women.
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Affiliation(s)
- Katherine Scott
- Department of Internal Medicine and Aged Care, Obstetric Medicine Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
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