Evaluation of cocaine use during pregnancy through toxicological analysis of hair

Assessment of exposure to drugs of abuse during pregnancy by hair analysis in a Mediterranean island

AIMS

  This study aims to estimate the prevalence of drug use by pregnant women living in Ibiza, using structured interviews and biomarkers in maternal hair. In addition, the potentially detrimental effects of maternal drug abuse on their newborns were investigated. Ibiza has a large international night-life resort associated with clubs, music and use of recreational drugs.

DESIGN, SETTING AND PARTICIPANTS

  Hair samples were collected prospectively from January to March 2010 from a cohort of consecutive mothers after giving birth in the Hospital Can Misses in Ibiza.

MEASUREMENTS

  Opiates, cocaine, cannabis, methadone, amphetamines, 3,4-methylenedioxymethamphetamine (MDMA) and their metabolites were detected in a 3-cm-long proximal segment of maternal hair corresponding to the last trimester of pregnancy by gas chromatography coupled to mass spectrometry (n = 107). Data on socio-demographic characteristics and on tobacco, alcohol, drugs of prescription and drugs of abuse consumption during pregnancy were collected using a structured questionnaire.

FINDINGS

  Hair analysis showed an overall 16% positivity for drugs of abuse in the third trimester of pregnancy, with a specific prevalence of cannabis, cocaine, MDMA and opiates use of 10.3, 6.4, 0.9 and 0%, respectively. In the questionnaires, only 1.9% of mothers declared using drugs of abuse during pregnancy. Gestational drug of abuse consumption was associated with active tobacco smoking, a higher number of smoked cigarettes and the mother being Spanish.

CONCLUSIONS

  Illicit drug use is substantially under-reported among pregnant women living in Ibiza, particularly among Spanish nationals. Voluntary, routine objective biological toxicology screening should be considered as part of routine examinations in antenatal clinics on this Mediterranean island.

Fetal effects of cocaine: an updated meta-analysis

BACKGROUND

A very large number of women in the reproductive age group consume cocaine, leading to grave concerns regarding the long term health of millions of children after in utero exposure. The results of controlled studies have been contradictory, leading to confusion, and, possible, misinformation and misperception of teratogenic risk.

OBJECTIVE

To systematically review available data on pregnancy outcome when the mother consumed cocaine.

METHODS

A meta-analysis of all epidemiologic studies based on a priori criteria was conducted. Comparisons of adverse events in subgroups of exposed vs. unexposed children were performed. Analyses were based on several exposure groups: mainly cocaine, cocaine plus polydrug, polydrug but no cocaine, and drug free.

RESULTS

Thirty three studies met our inclusion criteria. For all end points of interest (rates of major malformations, low birth weight, prematurity, placental abruption, premature rupture of membrane [PROM], and mean birth weight, length and head circumference), cocaine-exposed infants had higher risks than children of women not exposed to any drug. However, most of these adverse effects were nullified when cocaine exposed children were compared to children exposed to polydrug but no cocaine. Only the risk of placental abruption and premature rupture of membranes were statistically associated with cocaine use itself.

CONCLUSIONS

Many of the perinatal adverse effects commonly attributed to cocaine may be caused by the multiple confounders that can occur in a cocaine using mother. Only the risk for placental abruption and PROM could be statistically related to cocaine. For other adverse effects, additional studies will be needed to ensure adequate statistical power.

Evaluation of cocaine, amphetamines and cannabis use in university students through hair analysis: preliminary results

The evaluation of drug abuse in a defined population was performed through toxicological hair analysis. Hair samples from university students ranging from 18 to 25 years of age were anonymously collected and screened for cocaine, amphetamines and cannabinoids by radioimmunoassay (RIA). Positive results (cut-off values adopted were 2 ng/mg for cocaine and amphetamines and 0.5 ng/mg for cannabinoids) were confirmed by GC/MS. Preliminary results showed 19% of positive results for cocaine on 200 samples analysed. No confirmed positive results were obtained for amphetamine analysis. RIA technique demonstrated its unsuitability for cannabinoids preliminary screening on hair, giving a high percent of false positive results.

Hair analysis for abused and therapeutic drugs

This review focuses on basic aspects and recent studies of hair analysis for abused and therapeutic drugs and is discussed with 164 references. Firstly, biology of hair and sampling of hair specimens have been commented for the sake of correct interpretation of the results from hair analysis. Then the usual washing methods of hair samples and the extraction methods for drugs in hair have been shown and commented on. Analytical methods for each drug have been discussed by the grouping of three analytical methods, namely immunoassay, HPLC-CE and GC-MS. The outcomes of hair analysis studies have been reviewed by dividing into six groups; morphine and related, cocaine and related, amphetamines, cannabinoids, the other abused drugs and therapeutic drugs. In addition, reports on stability of drugs in the living hair and studies on drug incorporation into hair and dose-hair concentration relationships have been reviewed. Applications of hair analysis to the estimation of drug history, discrimination between OTC drug use and illegal drug use, drug testing for acute poisoning, gestational drug exposure and drug compliance have also been reviewed. Finally, the promising prospects of hair analysis have been described.

Methods used to detect drug abuse in pregnancy: a brief review

A brief review of different methods adopted to assess foetal drug exposure is reported here. Various operative procedures have been described in the literature to detect drug abuse in pregnancy. All protocols can be clustered into two main groups: self-report and interview procedures and analytical methods. The latter can be performed on tissues and/or fluids withdrawn from the mother, from the new-born or both. The aim of this review is to analyse the capability of these different techniques and the suitability of the biological specimens in view of the lack of consensus on a method of choice. The results obtained and the conclusions are different between various authors. A brief discussion on the capability of the different techniques and biological specimens adopted for this purpose is presented.

The substance-abusing parturient: implications for analgesia and anaesthesia management

Substance abuse remains a major problem in society, while substance abuse in pregnancy has emerged as a major health problem in the 1990s. Due to this trend, obstetricians, neonatologists and anaesthesiologists are encountering an increasing number of pregnant patients who use licit and illicit substances. The use of these substances presents a multitude of problems for the patient, her unborn child, and the physicians involved in their care. The following article reviews the various substances of abuse use by pregnant women and the implications of their use for analgesia and anaesthesia during labour and delivery. In conclusion, it is essential for physicians to identify the substance abusing parturient to optimize care of these patients and be prepared for the crises that may arise.

Cocaine in pregnancy. Recent data on maternal and fetal risks

Cocaine continues to be abused during pregnancy, creating increased demands on the health care system. Epidemiology and basic science research have identified and confirmed risks of adverse maternal and fetal effects when cocaine is used during pregnancy. These effects of cocaine in pregnant women often are influenced by a number of confounding variables. This article reviews those cocaine effects as well as recent data, which examine in greater detail the risks of adverse outcomes of prenatal cocaine exposure during pregnancy.