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更高，出生体重较低的婴儿发生率更高，先天畸形和死亡率更高。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。关于母体血浆、尿液、唾液、汗液和头发中的药物浓度与羊水、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。我们设计了几项研究来调查母体和胎儿药物在各种生物液和组织中的处置情况。每个孕妇样本都提供了怀孕不同阶段的药物暴露史。胎儿样本提供了有关产前药物暴露的独特信息。胎粪在妊娠第13周开始形成，毛发在最后三个月开始形成。每个母体提供了机会来确定不同母体中的药物浓度是否与母体和新生儿结局指标有关。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，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有很大不同。对于早产儿来说，情况可能尤其如此。

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 within the general population. 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 relationships between maternaldrug concentration in plasma, urine, saliva, sweat and hair to amniotic fluid, cord blood, fetal urine, meconium and fetal hair. We have designed several studies to investigate maternal and fetal drug disposition in a variety of biological fluid and tissues. Each maternal specimen provides a history of drug exposure at different stages of gestation. Fetal specimens offer unique information about prenatal drug exposure. Meconium begins to be formed in the 13th week of gestation and hair in the last trimester. Each matrix offers the opportunity to determine if drug concentrations in different matrices relate to maternal and neonatal outcome measures. 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 that drug and metabolite profiles in neonatal specimens may be quite different than those found in adult biological fluids. This may be especially true for premature infants.