title: Perinatal effects of combined use of heroin, methadone, and amphetamine during pregnancy and quantitative measurement of metabolites in hair.
abstract: OBJECTIVE
  There has been very limited research on the clinical features of newborns exposed to combined use of heroin, methadone, and amphetamine in the uterus. We describe a technique for the quantification of drug metabolites in neonatal hair samples.
  
  
  METHODS
  In a tertiary neonatal care center in Taiwan, three neonates whose mothers self-reported heroin abuse with methadone treatment during pregnancy were studied. Involuntary exposure to amphetamine was not suspected before the births. To assess long-term illicit drug exposure during pregnancy, a quantifying technique of gas chromatography/mass spectrometry (GC/MS) for hair samples from neonates was developed to replace current methods for urine and blood specimens.
  
  
  RESULTS
  All three mothers were addicted to heroin and prescribed oral methadone treatment during pregnancy. Two males and one female were born and then admitted to the neonatal intensive care unit because of apparent neonatal abstinence syndrome (NAS) after birth. Additional hypertonicity and cerebral dysfunction were also diagnosed by electroencephalography in one case. Supportive care was given to the neonates, unless special treatments were needed in responding to tachypnea, fetal distress, or withdrawal symptoms. During follow-up periods from 10 months to 15 months, the signs of NAS remained and delays in milestones of development were observed. Further follow-up on the infants' neurobehavioral development is necessary. Measurement results of neonates' hair samples revealed high levels of metabolites of heroin, methadone, and amphetamine, reflecting the amount of illicit drug exposure 2-3 months before delivery.
  
  
  CONCLUSIONS
  The current study suggested the possibility of polydrug exposure, which was previously unknown in pregnant women in Taiwan. Measurement of neonatal hair samples could provide a basis for clinical evaluation and potential corresponding treatment.
authors.affiliation: Division of Genetics, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung City, Taiwan.
authors.forename: Pen-Hua
authors.initials: PH
authors.lastname: Su
authors.forename: Yan-Zin
authors.initials: YZ
authors.lastname: Chang
authors.forename: Chen
authors.initials: C
authors.lastname: Yang
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Ng
authors.forename: Jia-Yuh
authors.initials: JY
authors.lastname: Chen
authors.forename: Su-Chin
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000661:Amphetamine / Q000378:metabolism*; D004569:Electroencephalography; D005260:Female; D005333:Fetus / Q000187:drug effects* / Q000378:metabolism; D008401:Gas Chromatography-Mass Spectrometry; D006197:Hair / Q000737:chemistry*; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008691:Methadone / Q000378:metabolism / Q000627:therapeutic use*; D009357:Neonatal Abstinence Syndrome / Q000175:diagnosis*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*
chemical_list: D000661:Amphetamine; D008691:Methadone