Using umbilical cord tissue to detect fetal exposure to illicit drugs: a multicentered study in Utah and New Jersey

Abstract

Objective:We assessed umbilical cord tissue as a means of detecting fetal exposure to five classes of drugs of abuse.Study Design: In a multicentered study in Utah and New Jersey, we collected umbilical cord tissue when high-risk criteria were met for maternal illicit drug use. The deidentified umbilical cord specimens were analyzed for five drug classes: methamphetamine, opiates, cocaine, cannabinoids and phencyclidine. For each umbilical cord specimen, an enzyme-linked immunosorbent assay (ELISA)-based screening test was compared with a 'gold standard' test, consisting of gas or liquid chromatography tandem mass spectrometry.Result: A total of 498 umbilical cord samples were analyzed of which 157 (32%) were positive using mass spectrometric detection. The sensitivity and specificity of the ELISA-based test for each class of drugs tested were as follows: methamphetamine 97 and 97%, opiates 90 and 98%, cocaine 90 and 100%, cannabinoids 96 and 98% and phencyclidine (only 1 of the 498 umbilical cord sample was positive for phencyclidine) 100 and 100%. Conclusion:We judge that the performances of the ELISA-based tests are sufficient for clinical testing of fetal exposure to methamphetamine, opiates, cocaine and cannabinoids. Studies obtained on umbilical cord tissue can result in a more rapid return to the clinician than meconium testing, because waiting for meconium to be passed sometimes requires many days. Moreover, in some cases the meconium is passed in utero making collection impossible, whereas umbilical cord tissue should always be available for drug testing.

Methadone, Cocaine, Opiates, and Metabolite Disposition in Umbilical Cord and Correlations to Maternal Methadone Dose and Neonatal Outcomes

“…In addition, the authors did not report any data on metabolites analyzed or measured concentrations in each matrix. The authors also extended their findings by screening and confirming 500 umbilical cord specimens from women suspected of illicit drug consumption (52), obtaining negative and positive predictive values >98% and >70%, respectively, for methamphetamine, cocaine, opiates, cannabinoids and phencyclidine. Their data supported the efficacy of this alternative matrix for detection of fetal drug exposure; however, data were not available to establish the window of drug detection in umbilical cord.…”

Agreement of umbilical cord drug and cotinine levels with maternal self-report of drug use and smoking during pregnancy

“…In addition, they found that ELISA-based tests (9) can be used to assess fetal exposure to drugs of abuse, with extremely high negative predictive values (>98%) compared with mass-spectrometer.…”

Simultaneous quantification of buprenorphine, norbuprenorphine, buprenorphine-glucuronide and norbuprenorphine-glucuronide in human umbilical cord by liquid chromatography tandem mass spectrometry

“…Recently, Lozano et al [3] and Gray and Huestis [4] published reviews on specimens for monitoring in utero drug exposure. In newborns, neonatal hair [5, 6] and meconium [7–10] have proven useful, as well as umbilical cord tissue, an interesting alternative matrix for fetal drug exposure detection [11, 12 ]. Umbilical cord offers advantages over hair because many parents reject hair collection for cosmetic or cultural reasons, while umbilical cord is considered a waste product.…”