title: A case-control study of maternal periconceptual and pregnancy recreational drug use and fetal malformation using hair analysis.
abstract: OBJECTIVE
  Maternal recreational drug use may be associated with the development of fetal malformations such as gastroschisis, brain and limb defects, the aetiology due to vascular disruption during organogenesis. Using forensic hair analysis we reported evidence of recreational drug use in 18% of women with a fetal gastroschisis. Here we investigate this association in a variety of fetal malformations using the same method.
  
  
  METHODS
  In a multi-centre study, women with normal pregnancies (controls) and those with fetal abnormalities (cases) gave informed consent for hair analysis for recreational drug metabolites using mass spectrometry. Hair samples cut at the root were tested in sections corresponding to 3 month time periods (pre and periconceptual period).
  
  
  RESULTS
  Women whose fetus had gastroschisis, compared to women with a normal control fetus, were younger (mean age 23.78 ± SD4.79 years, 18-37 vs 29.79 ± SD6 years, 18-42, p = 0.00001), were more likely to have evidence of recreational drug use (15, 25.4% vs 21, 13%, OR2.27, 95thCI 1.08-4.78, p = 0.028), and were less likely to report periconceptual folic acid use (31, 53.4% vs 124, 77.5%, OR0.33, 95thCI 0.18-0.63, p = 0.001). Age-matched normal control women were no less likely to test positive for recreational drugs than women whose fetus had gastroschisis. After accounting for all significant factors, only young maternal age remained significantly associated with gastroschisis. Women with a fetus affected by a non-neural tube central nervous system (CNS) anomaly were more likely to test positive for recreational drugs when compared to women whose fetus was normal (7, 35% vs 21, 13%, OR3.59, 95th CI1.20-10.02, p = 0.01).
  
  
  CONCLUSIONS
  We demonstrate a significant association between non neural tube CNS anomalies and recreational drug use in the periconceptual period, first or second trimesters, but we cannot confirm this association with gastroschisis. We confirm the association of gastroschisis with young maternal age.
authors.affiliation: Institute for Women's Health, University College London, and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Anna L
authors.initials: AL
authors.lastname: David
authors.affiliation: Institute for Women's Health, University College London, and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Holloway
authors.affiliation: Institute for Women's Health, University College London, and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Louise
authors.initials: L
authors.lastname: Thomasson
authors.affiliation: Harris Birthright Centre, King's College Hospital, London, United Kingdom.
authors.forename: Argyro
authors.initials: A
authors.lastname: Syngelaki
authors.affiliation: Harris Birthright Centre, King's College Hospital, London, and Institute for Women's Health, University College London, United Kingdom.
authors.forename: Kypros
authors.initials: K
authors.lastname: Nicolaides
authors.affiliation: Fetal Medicine Unit, St Michael's Hospital, Bristol, United Kingdom.
authors.forename: Roshni R
authors.initials: RR
authors.lastname: Patel
authors.affiliation: North-Thames Cleft Lip and Palate Unit, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: Brian
authors.initials: B
authors.lastname: Sommerlad
authors.affiliation: Birmingham Women's Hospital, Birmingham, United Kingdom.
authors.forename: Amie
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Birmingham Women's Hospital, Birmingham, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Martin
authors.affiliation: Clinical and Molecular Genetics Unit, UCL Institute of Child Health, and University College London Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Lyn S
authors.initials: LS
authors.lastname: Chitty
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D020785:Central Nervous System Vascular Malformations / Q000209:etiology; D005260:Female; D005333:Fetus / Q000002:abnormalities; D020139:Gastroschisis / Q000209:etiology; D006197:Hair / Q000737:chemistry*; D006801:Humans; D013287:Illicit Drugs / Q000633:toxicity*; D008423:Maternal Age; D018811:Maternal Exposure; D008431:Maternal-Fetal Exchange; D008875:Middle Aged; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D015813:Substance Abuse Detection; D055815:Young Adult
chemical_list: D013287:Illicit Drugs