Umbilical Cord Tissue and Meconium May Not Be Equivalent for Confirming in Utero Substance Exposure

Colby, Jennifer M.; Adams, Bradley C.; Morad, Anna; Presley, Lauren D.; Patrick, Stephen W.

doi:10.1016/j.jpeds.2018.09.046

Cited by 15 publications

(15 citation statements)

References 24 publications

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“…[49][50][51][52][53] Although some studies have suggested equivalence between meconium and umbilical cord tissue testing, 53 others studies have found the paired testing of meconium and umbilical cord tissue to be discordant. 54 Clinicians should be mindful of the differences in testing modalities when considering their needs for testing and work with their laboratories to determine the best testing modality in their setting.…”

Section: Screening and Testing: Mother And Infantmentioning

confidence: 99%

Neonatal Opioid Withdrawal Syndrome

et al. 2020

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The opioid crisis has grown to affect pregnant women and infants across the United States, as evidenced by rising rates of opioid use disorder among pregnant women and neonatal opioid withdrawal syndrome among infants. Across the country, pregnant women lack access to evidence-based therapies, including medications for opioid use disorder, and infants with opioid exposure frequently receive variable care. In addition, public systems, such as child welfare and early intervention, are increasingly stretched by increasing numbers of children affected by the crisis. Systematic, enduring, coordinated, and holistic approaches are needed to improve care for the mother-infant dyad. In this statement, we provide an overview of the effect of the opioid crisis on the mother-infant dyad and provide recommendations for management of the infant with opioid exposure, including clinical presentation, assessment, treatment, and discharge.

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Section: Screening and Testing: Mother And Infantmentioning

confidence: 99%

Neonatal Opioid Withdrawal Syndrome

et al. 2020

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“…They found an agreement of 100% for negative results and an agreement of 59% for positive results, showing meconium to be more sensitive. Colby et al 18 compared paired umbilical cord and meconium results from 501 neonates for cannabis and other drugs. The target analyte was THCCOOH in both matrices; meconium cutoff was 30 ng/g, and umbilical cord cutoff changed from 150 to 1 ng/g in the middle of the project.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, Jensen et al 17 reported a lower sensitivity for umbilical cord, and Colby et al 18 concluded that the results between meconium and umbilical cord were discordant and did not produce equivalent results. These differences may be explained due to the different types of samples (paired vs. unpaired) included in these studies, and the different metabolites and cutoffs employed in meconium and umbilical cord analysis.…”

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confidence: 99%

Assessment of biological matrices for the detection of in utero cannabis exposure

Concheiro

Gutierrez

Ocampo

et al. 2021

Drug Testing and Analysis

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Cannabis consumption has been increasing worldwide among pregnant women. Due to the negative effects of prenatal cannabis exposure, it is necessary to develop an objective, sensitive, and specific method to determine cannabinoids use during pregnancy. In this study, we compared four different biological samples, maternal hair, meconium, umbilical cord, and placenta, for the detection of in utero cannabis exposure. The biological samples were collected from 627 mother-newborn dyads. All hair and meconium samples were analyzed, and umbilical cord and placenta if hair and/or meconium were positive for cannabinoids. Meconium and hair showed to complement each other, with an agreement between hair and meconium results of 96.7% but only 34.3% if just positive results were considered. Umbilical cord and placenta results showed a better agreement with meconium (91.3% and 92.6%, respectively) than with hair (39.1% and 34.6%, respectively). The predominant metabolites in meconium were 11-nor-carboxy-THC (THCCOOH) and 8,11-dihydroxy-THC (diOHTHC), and in umbilical cord and placenta was THCCOOH-glucuronide. Cannabidiol (CBD) and cannabinol (CBN) were detected in meconium but not in any umbilical cord or placenta. For the first time, prenatal marijuana exposure was analyzed and compared in paired hair, meconium, umbilical cord, and placental samples.Hair and meconium positivity rate was similar, but a more sensitive and specific analytical method for the hair may resolve discrepancies between the matrices. Umbilical cord and placenta may be considered suitable alternative matrices to meconium through the determination of THCCOOH-glucuronide as a biomarker of cannabis exposure.

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“…Further, there is over 90% concordance for all drugs tested between meconium and cord blood, indicating that it is an important biofluid that can be used to rule out in utero exposure. While both umbilical cord tissue and meconium are used to confirm in utero substance exposure, the results are not necessarily equivalent [35].…”

Section: Meconiummentioning

confidence: 99%

What the lab can and cannot do: clinical interpretation of drug testing results

Kapur¹,

Aleksa²

2020

Critical Reviews in Clinical Laboratory Sciences

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Urine drug testing is one of the objective tools available to assess adherence. To monitor adherence, quantitative urinary results can assist in differentiating "new" drug use from "previous" (historical) drug use. "Spikes" in urinary concentration can assist in identifying patterns of drug use. Coupled chromatographic-mass spectrometric methods are capable of identifying very small amounts of analyte and can make clinical interpretation rather challenging, specifically for drugs that have a longer half-life. Polypharmacy is common in treatment and rehabilitation programs because of co-morbidities. Medications prescribed for comorbidities can cause drug-drug interaction and phenoconversion of genotypic extensive metabolizers into phenotypic poor metabolizers of the treatment drug. This can have significant impact on both pharmacokinetic (PK) and pharmacodynamic properties of the treatment drug. Therapeutic drug monitoring (TDM) coupled with PKs can assist in interpreting the effects of phenoconversion. TDM-PKs reflects the cumulative effects of pathophysiological changes in the patient as well as drug-drug interactions and should be considered for treatment medications/drugs used to manage pain and treat substance abuse. Since only a few enzyme immunoassays for TDM are available, this is a unique opportunity for clinical laboratory scientists to develop TDM-PK protocols that can have a significant impact on patient care and personalized medicine. Interpretation of drug screening results should be done with caution while considering pharmacological properties and the presence or absence of the parent drug and its metabolites. The objective of this manuscript is to review and address the variables that influence interpretation of different drugs analyzed from a rehabilitation and treatment programs perspective.

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Umbilical Cord Tissue and Meconium May Not Be Equivalent for Confirming in Utero Substance Exposure

Cited by 15 publications

References 24 publications

Neonatal Opioid Withdrawal Syndrome

Neonatal Opioid Withdrawal Syndrome

Assessment of biological matrices for the detection of in utero cannabis exposure

What the lab can and cannot do: clinical interpretation of drug testing results

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