Testing Unconventional Matrices to Monitor for Prenatal Exposure to Heroin, Cocaine, Amphetamines, Synthetic Cathinones, and Synthetic Opioids

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Substance Use in Pregnancy: Identifying Stigma and Improving Care

“…In the neonate, meconium is the most analyzed matrix but urine, hair, blood, umbilical cord tissues, and placenta can also be analyzed for the presence of substances. 41 When used, the role of specimen testing should be to monitor treatment goals, and positive testing should prompt treatment implementation or adjustment rather than discharge or punishment. Specimen testing performed only at delivery misses the opportunity to establish treatment and recovery during pregnancy and too often is used to justify removing the newborn from the parent’s custody and care.…”

Alternative matrices in forensic toxicology: a critical review

“…Illicit and licit drugs, used by mother during pregnancy, cross the placenta mainly by passive diffusion and, then, are accumulated in meconium by deposition via bile and the swallowed amniotic fluid [104]. Because meconium begins to form around 11-12th week of gestation (when a fetus begins swallowing amniotic fluid) and accumulates thereafter until birth [102,105], it has been used as alternative matrix for assessing prenatal exposure to drugs (theoretically along the second and third trimesters of pregnancy) [102,106,107]. In general, the frequent and chronic exposure to drugs, especially during third trimester of pregnancy, are required to produce positive results for drug(s) in meconium [108].…”

“…Others biomarkers in meconium have been determined for identification of fetal exposure to tobacco (nicotine and cotinine); cocaine, hydroxybenzoylecgonine, benzoylecgonine, ecgonine methyl ester and anhydroecgonine methyl ester); cannabis (THC-COOH); amphetamine, p-hydroxyamphetamine; methamphetamine p-hydroxymethamphetamine); heroin (6-MAM, morphine and codeine) [107,108,110]. In regards to NPS, in the literature, there are only a few reports on analytical method development and detection in authentic specimens (e.g., synthetic cathinones [120][121][122]).…”

“…However, this range of alternative specimens is not exhaustive and other fluids have been explored and proposed. The use of other fluids and tissues including bile [5], nails [217], bone marrow [218], umbilical cord [107,113,219] and others, as alternative matrices has been reviewed and discussed in the literature. In addition, tooth is another matrix that has been explored in forensic toxicology, especially considering its ability to resist to postmortem decomposition, environmental changes and other agents [220].…”

Pyrrolidinyl Synthetic Cathinones α-PHP and 4F-α-PVP Metabolite Profiling Using Human Hepatocyte Incubations

“…Both SCs were first identified in 2014 in material seized in the Japanese illegal drug market or for sale over the Internet [4,5]. α-PHP was recently involved in several combined drug intoxication fatalities [6][7][8][9][10]. All the cases involved the co-ingestion of other SCs, mainly α-pyrrolidinovalerophenone (α-PVP) and 3 ,4 -methylenedioxy-αpyrrolidinohexiophenone (MDPHP), or often opiates and/or benzodiazepines.…”