Unit of Forensic Toxicology, Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Università la Sapienza.
National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy.
Ther Drug Monit. 2020 Apr;42(2):205-221. doi: 10.1097/FTD.0000000000000719.
The prevalence of drug use during pregnancy continues to increase despite the associated serious adverse obstetrical outcomes, including increased risk of miscarriage, fetal growth restriction, brain development impairment, neonatal abstinence syndrome, preterm delivery, and stillbirths. Monitoring drug use during pregnancy is crucial to limit prenatal exposure and provide suitable obstetrical health care. The authors reviewed published literature reporting the concentrations of common drugs of abuse and new psychoactive substances (NPS), such as synthetic cathinones and synthetic opioids, NPS, and their metabolites using unconventional matrices to identify drug use during pregnancy and improve data interpretation.
A literature search was performed from 2010 to July 2019 using PubMed, Scopus, Web of Science scientific databases, and reports from international institutions to review recently published articles on heroin, cocaine, amphetamine, methamphetamine, synthetic cathinone, and synthetic opioid monitoring during pregnancy.
Meconium has been tested for decades to document prenatal exposure to drugs, but data regarding drug concentrations in amniotic fluid, the placenta, the umbilical cord, and neonatal hair are still lacking. Data on prenatal exposure to NPS are limited.
Maternal hair testing is the most sensitive alternative matrix for identifying drug use during pregnancy, while drug concentrations in the meconium, placenta, and umbilical cord offer the identification of prenatal drug exposure at birth. Adverse developmental outcomes for the infant make it critical to promptly identify maternal drug use to limit fetal exposure or, if determined at birth, to provide resources to the exposed child and family. Alternative matrices offer choices for monitoring and challenge laboratories to deliver highly sensitive and specific analytical methods for detection.
尽管与药物使用相关的严重产科不良结局（包括流产风险增加、胎儿生长受限、大脑发育损伤、新生儿戒断综合征、早产和死产）不断增加，但怀孕期间药物使用的流行率仍在持续上升。监测怀孕期间的药物使用对于限制产前暴露并提供合适的产科保健至关重要。作者回顾了已发表的文献，这些文献报告了常见的滥用药物和新型精神活性物质（NPS）的浓度，如合成卡西酮和合成阿片类物质、NPS 及其代谢物，使用非传统基质来识别怀孕期间的药物使用并改善数据解释。
作者使用 PubMed、Scopus、Web of Science 科学数据库以及国际机构的报告，从 2010 年至 2019 年 7 月进行了文献检索，以回顾最近发表的关于怀孕期间监测海洛因、可卡因、安非他命、甲基苯丙胺、合成卡西酮和合成阿片类物质的文章。
几十年来，已经对胎粪进行了检测，以记录胎儿对药物的暴露情况，但关于羊水、胎盘、脐带和新生儿毛发中药物浓度的数据仍然缺乏。关于 NPS 产前暴露的数据有限。
母体头发检测是识别怀孕期间药物使用的最敏感替代基质，而胎粪、胎盘和脐带中的药物浓度则提供了出生时胎儿药物暴露的识别。婴儿的发育不良结果使得及时识别母体药物使用以限制胎儿暴露或在出生时确定药物暴露变得至关重要，以向暴露的儿童和家庭提供资源。替代基质为监测提供了选择，并对实验室提出了挑战，要求其提供高灵敏度和特异性的分析方法进行检测。
