Monitoring in utero drug exposure

与普通人群相比，吸毒妇女的妊娠并发症发生率较高，婴儿出生体重较低，先天畸形和死亡率较高。此外，由于新生儿禁欲综合征，延长住院时间的患病率也有所增加。药物暴露婴儿发生不良事件的风险可直接受剂量、滥用物质类别和宫内暴露时间的影响。此外，多种药物的使用也可能对胎儿的发育结果产生影响。为了更好地了解非法和合法物质对发育中的胎儿的作用，我们有必要开发改进的检测方法，并更好地了解药物通过胎盘膜的转运过程。关于孕妇血浆、尿液、唾液、汗液和头发中的浓度与羊水、脐带血、胎儿尿液、胎粪和胎儿毛发之间的关系，现有的数据有限。我们已经设计并正在合作进行几项研究，以调查各种物质与母体和胎儿处置的关系。每个孕妇样本都提供了怀孕不同阶段的药物暴露史。胎儿标本提供了在不同时间点检查药物发生情况的机会。由于已知胎粪在妊娠第13周开始发育，毛发在最后三个月开始发育，你不会期望看到母亲在怀孕中期停止使用任何物质，只有在胎粪中才会看到胎儿毛发中停止使用任何物质。每一种矩阵都提供了独特的机会来检查在子宫中暴露的药物的处置。此外，由于药物在胎儿体内的浓度很低，有必要开发灵敏和选择性的方法来检测这些化合物。分析方法正在改进，以提供更灵敏和可靠的方法来检测母体药物和鸦片类药物的代谢物，包括丁丙诺啡和美沙酮、可卡因、甲基苯丙胺、大麻素和尼古丁。在子宫暴露后测量药物的分析挑战之一是发现新生儿样本中的药物和代谢物可能与成人生物液中的药物和代谢物特征截然不同。对于早产儿来说尤其如此。

Drug-abusing women have higher rates of pregnancy complications and an increased incidence of infants with lower birth weights and higher rates of congenital malformations and mortality than are seen with the general populations. In addition, there is an increased prevalence for longer hospitalization due to neonatal abstinence syndrome. The risk of adverse events in drug-exposed infants can be directly influenced by dose, class of abused substance and time of intrauterine exposure. In addition, poly-drug use may also have an effect on the developmental outcome of the fetus. To better understand the role illicit and licit substances have on the developing fetus, it is necessary that we develop improved methods of detection and gain a better understanding of the transport process involved in the transfer of drug across the placental membrane. Limited data are available correlating the relationship between maternal concentration as seen in plasma, urine, saliva, sweat and hair to amniotic fluid, cord blood, fetal urine, meconium and fetal hair. We have designed and are working in collaboration on several studies to investigate the relationship of maternal and fetal disposition of a variety of substances. Each maternal specimen gives a history of drug exposure at different stages of gestation. Fetal specimens offer the opportunity to examine the occurrence of drugs at different time points. Since it is known that meconium starts developing in the 13th week of gestation and hair in the last trimester, you would not expect to see any substance the mother stopped using in the second trimester in fetal hair only in meconium. Each matrix offers the unique opportunity to examine the disposition of drugs exposed in utero. In addition, due to the low concentrations of drugs in fetal matrices, it is necessary to develop sensitive and selective methods for detecting these compounds. Analytical methods are being improved to offer more sensitive and reliable methods of detecting the parent drug and metabolites of opiates, including buprenorphine and methadone, cocaine, methamphetamine, cannabinoids and nicotine in a variety of maternal and infant specimens. One of the analytical challenges in measurement of drugs following in utero exposure is the finding that drug and metabolite profiles in neonatal specimens may be quite different than those found in adult biological fluids. This is especially true with premature infants.