Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, the Department of Pathology, and the Department of Pediatrics, University of Utah Health, the Division of Maternal Fetal Medicine, Women and Newborns Clinical Program, Intermountain Healthcare, the Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, and ARUP Laboratories, Salt Lake City, Utah.
Obstet Gynecol. 2022 Aug 1;140(2):153-162. doi: 10.1097/AOG.0000000000004868. Epub 2022 Jul 6.
Our primary objective was to estimate statewide prenatal substance exposure based on umbilical cord sampling. Our secondary objectives were to compare prevalence of prenatal substance exposure across urban, rural, and frontier regions, and to compare contemporary findings to those previously reported.
We performed a cross-sectional prevalence study of prenatal substance exposure, as determined by umbilical cord positivity for 49 drugs and drug metabolites, through the use of qualitative liquid chromatography-tandem mass spectrometry. All labor and delivery units in Utah (N=45) were invited to participate. Based on a 2010 study using similar methodology, we calculated that a sample size of at least 1,600 cords would have 90% power to detect 33% higher rate of umbilical cords testing positive for any substance. Deidentified umbilical cords were collected from consecutive deliveries at participating hospitals. Prevalence of prenatal substance exposure was estimated statewide and by rurality using weighted analysis.
From November 2020 to November 2021, 1,748 cords (urban n=988, rural n=384, frontier n=376) were collected from 37 hospitals, representing 92% of hospitals that conduct 91% of births in the state. More than 99% of cords (n=1,739) yielded results. Statewide, 9.9% (95% CI 8.1-11.7%) were positive for at least one substance, most commonly opioids (7.0%, 95% CI 5.5-8.5%), followed by cannabinoid (11-nor-9-carboxy-delta-9-tetrahydrocannabinol [THC-COOH]) (2.5%, 95% CI 1.6-3.4%), amphetamines (0.9%, 95% CI 0.4-1.5), benzodiazepines (0.5%, 95% CI 0.1-0.9%), alcohol (0.4%, 95% CI 0.1-0.7%), and cocaine (0.1%, 95% CI 0-0.3%). Cord positivity was similar by rurality (urban=10.3%, 95% CI 8.3-12.3%, rural=7.1%, 95% CI 3.5-10.7%, frontier=9.2%, 95% CI 6.2-12.2%, P=.31) and did not differ by substance type. Compared with a previous study, prenatal exposure to any substance (6.8 vs 9.9%, P=.01), opioids (4.7 vs 7.0% vs 4.7%, P=.03), amphetamines (0.1 vs 0.9%, P=.01) and THC-COOH (0.5 vs 2.5%, P<.001) increased.
Prenatal substance exposure was detected in nearly 1 in 10 births statewide.
我们的主要目标是通过脐带抽样来估计全州的产前物质暴露情况。我们的次要目标是比较城市、农村和边境地区产前物质暴露的流行率，并将当前的发现与之前的报告进行比较。
我们通过使用定性液相色谱-串联质谱法，对 49 种药物和药物代谢物的脐带阳性进行了产前物质暴露的横断面患病率研究。犹他州的所有分娩和分娩单位（N=45）都被邀请参加。根据 2010 年使用类似方法进行的一项研究，我们计算出，样本量至少为 1600 根脐带，将有 90%的能力检测到任何物质阳性的脐带检测率高出 33%。在参与医院连续分娩时收集无身份识别的脐带。使用加权分析方法估计全州和农村地区产前物质暴露的流行率。
从 2020 年 11 月至 2021 年 11 月，从 37 家医院收集了 1748 根脐带（城市 n=988，农村 n=384，边境 n=376），代表了在该州进行 91%分娩的 92%的医院。超过 99%的脐带（n=1739）得出了结果。全州范围内，有 9.9%（95%CI 8.1-11.7%）至少有一种物质呈阳性，最常见的是阿片类药物（7.0%，95%CI 5.5-8.5%），其次是大麻素（11-去甲-9-羧基-δ-9-四氢大麻酚[THC-COOH]）（2.5%，95%CI 1.6-3.4%），苯丙胺（0.9%，95%CI 0.4-1.5%），苯二氮䓬类（0.5%，95%CI 0.1-0.9%），酒精（0.4%，95%CI 0.1-0.7%）和可卡因（0.1%，95%CI 0-0.3%）。农村地区的脐带阳性率相似（城市=10.3%，95%CI 8.3-12.3%，农村=7.1%，95%CI 3.5-10.7%，边境=9.2%，95%CI 6.2-12.2%，P=.31），且与物质类型无关。与以前的研究相比，任何物质的产前暴露（6.8%比 9.9%，P=.01）、阿片类药物（4.7%比 7.0%，P=.03）、苯丙胺（0.1%比 0.9%，P=.01）和 THC-COOH（0.5%比 2.5%，P<.001）增加。
全州范围内近 10%的分娩中检测到产前物质暴露。
