| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
ORIGINAL RESEARCH |
From the Departments of Pediatrics and Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; and Exempla St. Joseph Hospital, Denver, Colorado.
Address reprint requests to: Karen F. Buchi, MD, Department of Pediatrics, University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132; E-mail: karen.buchi{at}hsc.utah.edu.
 |
ABSTRACT |
|---|
TOP
 ABSTRACT MATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
METHODS: Thirteen well baby nurseries in calendar year 2000 and six neonatal intensive care units (NICUs) in 2001–2002 collected anonymous meconium samples and associated, but nonidentifiable, demographic data on consecutively born infants. Samples were screened by enzyme immunoassay and confirmed by gas chromotography/mass spectroscopy for methamphetamines, cannabinoids, and benzoylecognine.
RESULTS: Meconium samples were collected from 1202 well baby nursery infants and 317 NICU infants. There were no significant differences in the rates of positivity for methamphetamines (0.6% versus 0.4%) or marijuana (2.9% versus 1.8%) between the 1991 and 2000/2001 studies. Cocaine prevalence declined from 1.1% in 1991 to 0.3% in 2000/2001 (P = .04). The prevalence of positivity for any of these three drugs declined over the 10-year period from 4.4% to 2.4% (P = .02). The prevalence for positivity for any of these three drugs was higher in the NICUs (4.7%) than in the well baby nurseries (1.9%, P = .008).
CONCLUSION: The rate of drug-positive infants declined during the decade of the 1990s in a geographic area that is experiencing a sharp rise in the use of methamphetamine among women of childbearing age. Further studies that focus on women of childbearing age who use methamphetamine may help determine factors that impact their drug use during pregnancy and after the infant is born.
Research clearly shows that infants born to drug- and alcohol-abusing mothers are at risk for developmental and behavioral problems resulting from prenatal exposure and dysfunctional parenting.1,2 It is important for prenatal and pediatric care providers to be aware of evolving trends in maternal substance abuse to improve detection and facilitate intervention. During the 1990s, the use of methamphetamine increased in prevalence throughout the West and Southwest United States, and there is evidence that the problem is currently reaching into rural and urban areas of the South and Midwest.3 In 1991, 0.38% of the total admissions for substance abuse treatment in Utah were for methamphetamine addiction. By 2001, that percentage had risen to 18.5%, outpacing marijuana as the primary illicit drug of choice for patients in treatment.4 In 2001, 37% of the female treatment population in Utah were treated for addiction to methamphetamine, compared with 1.2% in 1992. This study was undertaken to investigate the impact of the alarming and changing patterns of drug abuse in women of childbearing age in Utah on the newborn population.
The first objective of this study was to estimate the current prevalence of prenatal exposure to methamphetamines and other drugs of abuse among infants born in northern Utah. The second objective was to compare the results of this study with those of a maternal substance abuse prevalence study performed in 1991 in the same geographic area.5
|
MATERIALS AND METHODS |
|---|
|
TOP
ABSTRACTMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
2 analysis for discrete variables, Student two-sided t test for continuous variables, and stepwise logistic regression for multivariate regression. A P value of < .05 was considered to be significant. |
RESULTS |
|---|
|
TOP
ABSTRACTMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
Table 1
reports the drug screen results of the 2000/2001 study in comparison with the 1991 maternal urine study. There were no significant differences in the rates of positivity for methamphetamine or marijuana between the 1991 and 2000/2001 studies. Cocaine prevalence declined from 1.1% in 1991 to 0.3% in 2000/2001 (P = .04). Overall, the prevalence of positivity for any of these three drugs declined over the 10-year period from 4.4% to 2.4% (P =.02).
|
). There were no significant differences between the two groups in regard to maternal age, minority status, insurance status, or history of maternal alcohol use. Meconium samples positive for cocaine, methamphetamine, and/or marijuana were more likely to be associated with mothers who were unmarried, had a reported history of maternal tobacco use or a history of maternal social drug use, and had infants of lower birth weight and younger gestational age. A stepwise logistic regression was performed using meconium results for cocaine, methamphetamines, or marijuana as the dependent variable and the factors found to be associated with positivity with univariate analysis as the independent variables. Only a reported history of maternal tobacco use and social drug use remained independently associated with drug positivity.
|
. The prevalence of marijuana-positive samples was higher in the NICU cohort (3.2%) than in the well baby nursery cohort (1.4%, P = .05). Overall, the prevalence for positivity for any of these three drugs was higher in the NICU cohort (4.7%) than in the well baby nursery cohort (1.9%, P = .008).
|
|
DISCUSSION |
|---|
|
TOP
ABSTRACTMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
Although the study performed in 2000/2001 analyzed meconium and not maternal urine, as in the 1991 study, this difference in methodology does not impact the finding of a decreasing prevalence. Urine drug screens can detect drug metabolites up to 72 hours after use, whereas meconium screening can detect use from 20 weeks’ gestation onward.7 The fact that the rate of drug detection decreased when a more sensitive test was used for analysis indicates a true decrease in prevalence.
We were particularly interested in the current prevalence of methamphetamine positivity because of the rapid increase in its use by women as reported by the Utah Division of Substance Abuse.4 The Division collects extensive information on individuals seeking drug treatment that includes primary, secondary, and tertiary drugs of abuse. From 1992 to 2001, the percentage of women reporting methamphetamine to be their primary substance of use rose from 1.2% to 37%. We were surprised to find no difference in the rate of methamphetamine positivity between the 2000/2001 and the 1991 studies. We do not believe that our study methodology can explain this. Meconium analysis is a well-established and verified means of drug detection.8 Our samples came from the busiest hospitals in northern Utah, including six of the seven NICUs in the state. We questioned whether the time of year the samples were collected (summer through fall) influenced the findings. The substance abuse specialists in Utah, however, have not documented a variable supply of methamphetamine in the community from season to season and attribute this to the relative ease of its manufacture at the local level. Our findings are similar to findings reported by Derauf et al in Hawaii, presented at the 2001 Society for Pediatric Research meeting (Derauf C, Katz A, Easa D. The prevalence of methamphetamine and other drug use during pregnancy [abstract]. Pediatr Res 2001;49:166A). They, too, had data based primarily on drug treatment admissions that suggested the methamphetamine abuse is epidemic in Hawaii. In their anonymous meconium screening study, they found a rate of less than 1% for methamphetamine.
We have several theories about the reasons behind the lack of increase in methamphetamine-positive newborns despite the rise in use in the general female population. One reason may be that methamphetamine-abusing women have trouble getting pregnant and/or staying pregnant. Another may be that methamphetamine-abusing women, once they discover they are pregnant, abstain from use later in pregnancy, and thus the meconium screen will be negative. An explanation supported by anecdotal reports from users as reported by the Division of Substance Abuse is that methamphetamine use often begins after the infant is born, starting with the desire to lose weight and gain control, then turning into an addiction. Another theory could be that an increase in knowledge of clinicians and the general public about prenatal substance abuse over the past decade has had a positive impact on the prevalence of use during pregnancy. Further studies that focus on women of childbearing age who are methamphetamine users may help determine factors that impact their drug use during and after pregnancy.
|
Footnotes |
|---|
doi:10.1016/S0029-7844(02)03067-3
Received October 16, 2002. Received in revised form January 6, 2003. Accepted February 6, 2003.
|
REFERENCES |
|---|
|
TOP
ABSTRACTMATERIALS AND METHODSRESULTSDISCUSSIONREFERENCES |
|---|
2. Eyler FD, Behnke M. Early development of infants exposed to drugs prenatally. Clin Perinatol 1999;26:107–50.[Medline]
3. National Institutes of Health. Methamphetamine abuse and addiction. NIDA Research Report NIH publication no. 98-4210. Washington: National Institute of Drug Abuse, 1998.
4. 2001 Annual Report. Division of Substance Abuse, Department of Human Services, State of Utah, Salt Lake City, UT. Available at: http://www.hsdsa.state.ut.us/Annual_Report.htm. Accessed 2002 Sept 13.
5. Buchi K, Varner M, Chase R. The prevalence of substance abuse among pregnant women in Utah. Obstet Gynecol 1993;81:239–42.
6. 2000 National Household Survey on Drug Abuse. Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, Washington. Available at: http://samhsa.gov/oas/NHSDA/2kNHSDA/2kNHSDA.htm. Accessed 2002 Sept 13.
7. Schmitz J. Digestive and absorptive function. In: Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB, eds. Pediatric gastrointestinal disease. 2nd ed. St. Louis: Mosby, 1996:263–79.
8. Moore C, Negrusz A, Lewis D. Determination of drugs of abuse in meconium. J Chromatogr B 1998;713:137–46.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
