Wabuyele Simuli L, Colby Jennifer M, McMillin Gwendolyn A
ARUP Institute for Clinical and Experimental Pathology.
ARUP Laboratories, Salt Lake City, Utah.
Ther Drug Monit. 2018 Apr;40(2):166-185. doi: 10.1097/FTD.0000000000000485.
Maternal substance abuse during pregnancy is a growing problem with major public health and legal concerns. In utero substance exposure may adversely affect neonatal development; pregnancy outcome; and the long-term behavioral, cognitive, and developmental abilities of the child. Also, serious legal implications are associated with substance abuse during pregnancy, including charges of child abuse and neglect that may result in the removal of the neonate from parental care and loss of custodial rights. Timely detection of in utero drug exposure is necessary for early identification and effective management of exposed newborns. Accurate identification of drug-exposed newborns relies on maternal history; clinical presentation of the newborn; and laboratory testing of biological maternal matrices (ie, urine, blood, oral fluid, sweat, hair, and breast milk), neonatal matrices (ie, urine, meconium, hair, and umbilical cord blood and tissue), and/or matrices from both the mother and neonate (ie, placenta and amniotic fluid). Evaluation of biological matrices can account for in utero exposure at various stages of gestation and approximate the period (recent versus chronic use) of substance exposure. Each matrix has its own unique advantages and limitations in terms of ease of collection, the window of gestational exposure represented, and sensitivity for different parent drug analytes and metabolites, which must be carefully considered for accurate interpretation of results. Analytical approaches to sample preparation and analysis vary based on the complexity of these biological matrices. Immunoassays are routinely used for screening, and chromatographic separation coupled to mass spectrometry detection method is commonly used for definitive (confirmatory) testing. Some laboratories use a single technology for all testing. This review provides a discussion on approaches used to detect drug-exposed newborns, biological specimens that have been studied to identify and characterize drug exposures, example analytical methods for meconium and umbilical cord tissue as well as considerations surrounding the interpretation of results. A possible algorithm for testing is also proposed.
孕期母亲药物滥用是一个日益严重的问题，引发了重大的公共卫生和法律关注。子宫内药物暴露可能会对新生儿发育、妊娠结局以及儿童的长期行为、认知和发育能力产生不利影响。此外，孕期药物滥用还会带来严重的法律后果，包括虐待和忽视儿童的指控，这可能导致新生儿被剥夺父母监护权并失去抚养权。及时检测子宫内药物暴露对于早期识别和有效管理受暴露新生儿至关重要。准确识别药物暴露新生儿依赖于母亲病史、新生儿临床表现以及对母亲生物样本（如尿液、血液、口腔液、汗液、毛发和母乳）、新生儿样本（如尿液、胎粪、毛发、脐带血和组织）和/或母亲与新生儿两者的样本（如胎盘和羊水）进行实验室检测。对生物样本的评估可以说明孕期不同阶段的子宫内暴露情况，并估算药物暴露的时间段（近期使用与长期使用）。每种样本在采集的难易程度、所代表的孕期暴露窗口以及对不同母体药物分析物和代谢物的敏感性方面都有其独特的优势和局限性，为准确解读结果必须仔细考虑这些因素。基于这些生物样本的复杂性，样本制备和分析的方法各不相同。免疫测定法通常用于筛查，色谱分离与质谱检测方法联用通常用于确证（确认）检测。一些实验室对所有检测都使用单一技术。本综述讨论了用于检测药物暴露新生儿的方法、已用于识别和表征药物暴露的生物标本、胎粪和脐带组织示例分析方法以及结果解读相关的注意事项。还提出了一种可能的检测算法。
