Infant Stool Exposes Maternal Drug Use During Pregnancy

Neil Osterweil

October 08, 2015


NASHVILLE, Tennessee — When meconium, the first feces from a newborn, was used to screen for maternal drug use, nearly 15% of samples were positive for at least one illicit drug, according to a pilot study.

"The most frequent substances were marijuana and opiates, and those can have serious consequences for babies," said Gaurav Gupta, MD, PhD, from Tufts Medical Center in Boston. Amphetamines and cocaine were also found, he added.

In addition to signaling potential harm to the newborn, a positive screen should alert caregivers to the potential for maternal drug dependence and for possible child neglect, he said here at the College of American Pathologists 2015 Meeting.

In their retrospective analysis, Dr Gupta and his colleague, Barbarajean Magnani, PhD, MD, also from Tufts, used meconium screening to identify maternal drug use in samples collected from January 2013 to July 2014 at the Tufts Medical Center.

An immunoassay was used to test for the presence of amphetamines, cocaine metabolite, marijuana, opiates, and phencyclidine (PCP). Any positive sample was retested in the same laboratory with highly sensitive and highly specific tandem mass spectrometry. The cutoffs for confirmation were 5 ng/g for marijuana and 50 ng/g for opiates, amphetamines, and cocaine.

The test can reveal information about a mother's use of illicit drugs as far back as the twelfth week of gestation.

The most frequent substances were marijuana and opiates, and those can have serious consequences for babies.

Of the 192 samples screened, 28 (14.6%) tested positive for at least one drug. In two of the specimens, both marijuana and amphetamines were identified.

"The data from this pilot study suggest that a significant number of neonates are exposed to illicit substances in utero," the investigators write in their poster presentation. "Meconium analysis can be a very useful tool for identifying in utero illicit substance exposure in newborns."

Although maternal urine screening for drug use is available, there are situations where meconium testing might reveal valuable clinical information, said Srividya Sathiyamoorthy, MD, from the Sinai Hospital of Baltimore.

"For example, I could see using it when the mother tests negative on urine screening" but there is a suspicion of previous drug use, she told Medscape Medical News. "Apparently, with meconium testing, you can get up to 20 weeks of information, and in such a situation, it might prove useful," she said.

This study was internally funded. Dr Gupta, Dr Magnani, and Dr Sathiyamoorthy have disclosed no relevant financial relationships.

College of American Pathologists (CAP) 2015 Meeting. Poster 11. Presented October 5, 2015.


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