SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

M46
"THE MECONIUM PROJECT": AN ITALIAN-SPANISH JOINT STUDY TO ASSESS
EXPOSURE TO ILLICIT DRUGS DURING PREGNANCY AND BIRTH OUTCOMES
S. Pichini*, P. Zuccaro, E. Marchei, M. Pellegrini, J Murillo, C. Puig, O. Vail, R. Pacifici, 6 Garcia-Algar:
Istituto Superiore di Sanita, Rome Italy, V. Le Regina Elena 299, Rome, RM 00161, Italy
Servicio de Pediatria, Hospital del Mar, Barcelona, Spain
The accurate assessment of fetal exposure to drugs of abuse through the objective measure of biomarkers
could provide the basis for appropriate treatment and follow-up of new-borns, which can present symptoms
of drug withdrawal. Furthermore, information regarding the real prevalence of drugs of abuse use during
pregnancy could also be disclosed.
For the first time in Europe the "Meconium Project" aimed to estimate the prevalence of drug use by
pregnant women and the effects of exposure to illicit drugs during pregnancy on the mother, fetus, and
infant.
Between September 2002 and February 2004, among the mother-infant dyads from the Hospital del Mar,
the fourth biggest hospital of the city, 1439 dyads met eligibility criteria and 1151 (79%) of those eligible
agreed to participate in the study. Exposure was defined as an admission of use of cocaine, opiates or
amphetamines by structured interview or the presence of drugs and their metabolites in 24 and 48 h
meconium as determined by use of liquid chromatography-mass spectroscopy assay. Nonexposure was
defined as a negative drug use history by interview and a negative analytical result. When exposure could
not be confirmed, such as when meconium was not obtained or was inadequate for confirmatory analysis,
the mother-infant dyad was excluded (n =288).
Preliminary results on the analyzed 497 mother-infant dyads showed that structured interview disclosed a
0.8, 1.8 and 2.2% mothers exposed to opiates, cocaine and both drugs while only one mother declared
ecstasy consumption. Meconium analysis showed that prevalence of opiates, cocaine and combined drugs
exposure was 9.1,3.8 and 10.7%, respectively and confirmed the case of ecstasy use. Arecoline, the main
Areca nut alkaloid, was found in meconium specimens from 4 out of 10 Asiatic newborns, whose mothers
declared areca nut consumption during pregnancy.
A similar percentage of drug-exposed mothers were found between Spanish, American and African women
(11.5,9.9 and 8.6%, respectively), while only a 6.3% Asiatic women resulted drug consumers. Exposure
status caused a significant low birth weight in newborns from mothers exposed to cocaine (mean and S.D.=
2848 ± 315 g in newborns from cocaine mothers vs 3262 ±504 g in newborns from non-exposed mothers).
Other somatometric differences included crown-heel height.
Of the 4 newborns exposed to arecoline, one showed a low birth weight, low intrauterine growth,
hyporefiexia, hypotonia and a second presented a withdrawal neonatal syndrome by Finnegan test.
In conclusion, these preliminary findings indicate a prevalence of opiates, cocaine and amphetamines
consumption during pregnancy in this mixed mediterranean and non-european population lower that that
reported in the North-american pregnant women. The higher sensitivity of meconium analysis, already
demonstrated, in comparison to maternal interview, was confirmed making this test ideal for screening
maternal and fetal exposure to conventional and non-conventional drugs of abuse during pregnancy.
Keywords: Drugs ofAbuse, Exposure, Pregnancy
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