SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

M47
METHAMPHETAMINE AND AMPHETAMINE CONCENTRATIONS IN MECONIUM OF
NEONATES OF WOMEN ENROLLED IN THE IDEAL STUDY OF IN UTERO
METHAMPHETAMINE EXPOSURE
2
Zirong Zhao!, Jing Liu , Linda L. LaGasse 2 , Chris Derauf, Penny Gran!, Rizwan Shah 2 Amelia Arria"
William Haning 2 , Lynne M. Smith 2 , Barry Lester" and Marilyn A. Huestis l *: I Che~istry and Dru~
Metabolism, IRP, NIDA, NIH, Baltimore, MD 21224; .2 IDEAL Community Research Network
Background: Tobacco, cannabis and methamphetamine (MA) use by pregnant women can negatively impact
child development. The Infant Development, Environment, and Lifestyle (IDEAL) study is a multi-center,
longitudinal investigation of the effects of prenatal methamphetamine exposure. Meconium, a useful matrix for
identifYing in utero drug exposure, was employed to identify gestational drug use. Little published data are
available on MA detection in meconium.
Objective: To characterize the detection and quantification ~f MA, tobacco and cannabis in meconium compared
to self-report.
Method: Mothers who used tobacco, cannabis or alcohol during pregnancy were included in both MA-exposed
and control groups. Meconium samples were analyzed by EMIT (USDTL) for cannabinoids, cocaine, opiates,
amphetamines with cutoff concentrations of 40, 75, 150 and 500 nglg, respectively. Positive samples were
confirmed by GC/MS with cutoffs of 2 nglg for II-nor-L'l.9-carboxy-THC and 5 nglg for cocaine,
benzoylecgonine (BE), m-OH-BE, and cocaethylene, morphine, codeine, hydrocodone, hydromorphone, and
MA, amphetamine (AMP), and MDMA. Tobacco use was identified with an ELISA cotinine screen
(International Diagnostics Systems Corp., cutoff to nglg).
Results: Of the 13,808 mothers screened, 1631 were consented and 176 enrolled. MA exposed mothers (n=84)
were identified by self-report of gestational MA use and/or GCIMS confirmation of MA, AMP, and/or MDMA
in infant meconium. Comparison participants (n=92) were matched by race, birth weight, maternal education
and type of insurance, denied amphetamines use and had negative meconium results. Among the 1631 mothers,
self-reported use rates were 5.2% (amphetamines), 25% (tobacco) and 5.9% (cannabis). Positive meconium
screening rates were 3.6% for any amphetamine, 20% cotinine and 11.2% cannabis. For specimens that screened
positive, 40.7% of amphetamines and 20.2% of cannabis specimens were confirmed. EMIT sensitivity and
specificity were checked by reanalyzing 35 specimens from babies of women who reported MA use but had a
negative screen and 35 specimens from the control group that also tested negative. All controls' meconium
specimens were negative by GClMS (5-nglg), while 4 of35 specimens from self-reporters that screened negative
were found positive by GCIMS, albeit at low concentrations (MA 8 52 and AMP 5 - 26 nglg meconium).
Users reported administering MA by the fonowing routes: 48% smoked; 9% injected, II % sniffed, 6% ingested
and 26% used multiple routes of administration. On average, 68% of the meconium from neonates whose
mothers reported 3 nl trimester use had detectable MA, while detection rates were :::;10% for self-reported use
during the 1 st and/or 2nd trimesters. Mean±SD, median and range ofMA concentrations were 3674 ± 3406, 2623,
479 to 13,431 nglg meconium and AMP 569 ± 543, 403, 30 to 2000 nglg meconium in infants whose mothers
reported 3 nl trimester use. However, the highest MA (19,376 and 16,976 nglg) and AMP (2765 ng/g)
concentrations were found in offspring born to women who reported MA use only in the 1 st or 1 5t and 2 nd
trimesters, raising questions about the self-report. The log transformed meconium MA concentrations
significantly correlated with the frequency ofMA use in the 3 nl trimester (r=0.645, P=O.004), although variability
prevents prediction of frequency of use for an individual mother. AMP was always detected in MA positive
meconium. In 55% of the GCMS positive samples, the ratios of amphetamine to MA were 0.1 to 0.2; 14% were
less than 0.1 and 18% were 0.2 to 0.3.
Limitations: Data are preliminary as the IDEAL study continues to recruit; larger samples in the future may
strengthen or refute interim observations.
Conclusions: Meconium analysis for MA is a useful adjunct to self-report for identification of MA exposure;
however, the [reatest sensitivity was achieved with specimens collected from offspring of women who reported
use in the 3 r trimester. Further research is needed to determine if there are additional MA metabolites in
meconium that could improve the identification of MA-exposed infants.
Keywords; Methamphetamine, Meconium, In Utero Exposure
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