title: Heavy in utero ethanol exposure is associated with the use of other drugs of abuse in a high-risk population.
abstract: Many ethanol dependent women also use other drugs of abuse that may affect pregnancy outcome and long-term child neurodevelopment. This study investigated the association between drugs of abuse and concurrent use of ethanol in pregnancy. A study cohort of neonates with FAEE levels above 2 nmol per gram meconium, indicative of heavy in utero ethanol exposure, was identified (n=114). Meconium and hair analyses for the presence of other drugs of abuse were obtained for some of these neonates and the rates of drug exposure were compared with the rates in a cohort of neonates who were tested negative (FAEE below 2 nmol per gram meconium) for ethanol exposure (n=622). Odds ratios (ORs) for various drugs were calculated with ethanol exposure. A 15.5% positive rate for intrauterine ethanol exposure was detected. A high rate of in utero drug exposure was detected in neonates with and without in utero ethanol exposure, 60.5% versus 62.7% respectively. Neonates with heavy in utero ethanol exposure were almost twice as likely to be exposed to narcotic opiates (OR=1.90; 95% confidence interval [CI]: 1.13-3.20) and 3.3 times as likely to be exposed to amphetamine (OR=3.30; 95% CI 1.06-10.27) when compared to neonates with no ethanol exposure. Exposure to cannabinoids predicted less likely exposure to ethanol (OR=0.61; 95% CI: 0.38-0.98) and no significant difference was noted in the exposure to cocaine (OR=1.24, 95% CI: 0.81-1.91). Neonates suspected of heavy in utero ethanol exposure should be tested for other drugs of abuse and vice versa. Early detection of drug exposures can facilitate early intervention to both the neonate and the mother, thus decreasing the risk of long-term neurodevelopmental outcomes for the child, including secondary disabilities associated with fetal alcohol spectrum disorder.
authors.affiliation: Motherisk Program, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
authors.forename: Sarit
authors.initials: S
authors.lastname: Shor
authors.forename: Irena
authors.initials: I
authors.lastname: Nulman
authors.forename: Vivian
authors.initials: V
authors.lastname: Kulaga
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D000437:Alcoholism / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism; D000662:Amphetamines / Q000032:analysis; D002186:Cannabinoids / Q000032:analysis; D003042:Cocaine / Q000032:analysis; D004952:Esters / Q000032:analysis; D005227:Fatty Acids / Q000032:analysis; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders; D006197:Hair / Q000737:chemistry; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D008470:Meconium / Q000737:chemistry; D009022:Morphine Derivatives / Q000032:analysis; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis
chemical_list: D000662:Amphetamines; D002186:Cannabinoids; D004952:Esters; D005227:Fatty Acids; D009022:Morphine Derivatives; D003042:Cocaine