Department of Pathology and ARUP Laboratories, University of Utah Health, Salt Lake City, UT 84108, United States.
Department of Pediatrics, Academic General Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, United States.
Clin Chem. 2024 Jul 5;70(7):934-947. doi: 10.1093/clinchem/hvae018.
Substance use during pregnancy is common, as is biological testing that is intended to help identify prenatal exposures. However, there is no standardized requirement for biological testing with either maternal or newborn specimens, nor is there standardization related to when testing occurs, how frequently testing occurs, what specimen(s) to test, what substances to test for, or how to perform testing.
We review common specimen types tested to detect maternal and newborn substance exposure with a focus on urine, meconium, and umbilical cord tissue. We also review common analytical methods used to perform testing, including immunoassay, and mass spectrometry platforms. Considerations regarding the utilization of testing relative to the purpose of testing, the drug analyte(s) of interest, the specific testing employed, and the interpretation of results are emphasized to help guide decisions about clinical utilization of testing. We also highlight specific examples of unexpected results that can be used to guide interpretation and appropriate next steps.
There are strengths and limitations associated with all approaches to detecting substance exposure in pregnant persons as well as biological testing to evaluate a newborn with possible substance exposure. Standardization is needed to better inform decisions surrounding evaluation of substance exposures in pregnant people and newborns. If biological sampling is pursued, testing options and results must be reviewed in clinical context, acknowledging that false-positive and -negative results can and do occur.
怀孕期间物质滥用很常见，用于帮助识别产前暴露的生物检测也是如此。然而，无论是对母体还是新生儿样本进行生物检测，都没有标准化的要求，也没有与检测发生的时间、检测的频率、要检测的样本、要检测的物质、或如何进行检测相关的标准化。
我们回顾了用于检测母体和新生儿物质暴露的常见样本类型，重点是尿液、胎粪和脐带组织。我们还回顾了用于进行检测的常见分析方法，包括免疫测定和质谱平台。强调了与检测目的、关注的药物分析物、使用的特定检测以及检测结果的解释相关的检测利用方面的考虑，以帮助指导检测的临床应用决策。我们还突出了一些可以用于指导解释和适当的后续步骤的意外结果的具体示例。
在检测孕妇物质暴露以及评估可能有物质暴露的新生儿的生物检测方面，所有方法都有其优缺点。需要标准化，以便更好地告知围绕孕妇和新生儿物质暴露评估的决策。如果进行生物采样，则必须在临床背景下审查检测选项和结果，要承认可能会出现假阳性和假阴性结果。
