母婴二元组中检测子宫内阿片类药物和可卡因暴露的生物学筛查与诊断指标比较

Stabler Meagan, Giacobbi Peter, Chertok Ilana, Long Leann, Cottrell Lesley, Yossuck Panitan

The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH

Department of Sport Sciences With Joint Appointment to Department of Epidemiology, West Virginia University, School of Public Health, Morgantown, WV

Ther Drug Monit. 2017 Dec;39(6):640-647. doi: 10.1097/FTD.0000000000000447.

BACKGROUND

Opioid and cocaine antenatal substance use can result in significant obstetric and pediatric health implications. Accurate detection of in utero-exposed neonates can improve patient care and health outcomes. Therefore, the effectiveness of mother-infant biological and diagnostic indicators collected at labor and delivery to provide accurate detection of in utero opiate and cocaine exposure was assessed.

METHODS

A retrospective medical chart review included 335 mother-infant dyads exposed to antenatal substances who were delivered between January 2009 and March 2014. Mother-infant dyads were a subset of a larger retrospective cohort of 560 substance-using mothers, who had a valid meconium drug screen (MDS) and anesthesia before delivery. Alternative biological and diagnostic indicators of maternal urine drug screens (UDS), maternal substance use International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and neonatal exposure diagnostic ICD-9-CM codes were compared against MDS. Data were analyzed using classification accuracy measures.

RESULTS

Compared with MDS, maternal UDS had the highest sensitivity [0.52, 95% confidence interval (CI), 0.39-0.65] and specificity (0.88, 95% CI, 0.79-0.97) to detect intrauterine opiate exposure. Maternal substance use diagnosis had the highest sensitivity (0.39, 95% CI, 0.16-0.61) and maternal UDS had the highest specificity (1.00, 95% CI, 0.99-1.00) to detect intrauterine cocaine exposure. Cocaine exposure had significantly higher accuracy scores across detection methods compared with opiate exposure.

CONCLUSIONS

Alternative indicators collected at delivery were ineffective at identifying in utero substance exposure, especially neonatal-exposed ICD-9-CM codes. Low sensitivity scores indicate that many exposed neonates could be misdiagnosed or left untreated. Accurate antenatal exposure identification at delivery is an important form of tertiary assessment that warrants the development of improved screening methodology and standardization of hospital biological drug testing.

背景

阿片类药物和可卡因在产前使用会对产科和儿科健康产生重大影响。准确检测子宫内暴露的新生儿有助于改善患者护理和健康结局。因此，本研究评估了在分娩时收集的母婴生物学和诊断指标用于准确检测子宫内阿片类药物和可卡因暴露的有效性。

方法

一项回顾性病历审查纳入了2009年1月至2014年3月期间分娩的335对暴露于产前物质的母婴。母婴对是一个更大的回顾性队列中560名使用物质母亲的子集，这些母亲在分娩前进行了有效的胎粪药物筛查（MDS）和麻醉。将母亲尿液药物筛查（UDS）、母亲物质使用国际疾病分类第九版临床修订本（ICD-9-CM）编码以及新生儿暴露诊断ICD-9-CM编码等替代生物学和诊断指标与MDS进行比较。使用分类准确性指标对数据进行分析。

结果

与MDS相比，母亲UDS在检测子宫内阿片类药物暴露方面具有最高的敏感性[0.52，95%置信区间（CI），0.39 - 0.65]和特异性（0.88，95%CI，0.79 - 0.97）。母亲物质使用诊断在检测子宫内可卡因暴露方面具有最高的敏感性（0.39，95%CI，0.16 - 0.61），而母亲UDS在检测子宫内可卡因暴露方面具有最高的特异性（1.00，95%CI，0.99 - 1.00）。与阿片类药物暴露相比，可卡因暴露在各种检测方法中的准确性得分显著更高。