Monitoring In Utero Drug Exposure

与一般人口相比，吸毒妇女的妊娠并发症发生率较高，婴儿出生体重较轻的发生率较高，先天畸形和死亡率较高。此外，由于新生儿禁欲综合征而延长住院时间的流行率也有所增加。药物暴露的婴儿不良事件的风险可直接受到剂量、滥用物质的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，并更好地了解药物穿过胎盘膜的转运过程。关于母体血浆、尿液、唾液、汗液和毛发中的药物浓度与羊水、脐带血、胎尿、胎粪和胎毛之间的关系的数据有限。我们设计了几项研究，以调查母体和胎儿药物处置在各种生物液体和组织。每个母体样本提供了妊娠不同阶段的药物暴露史。 胎儿标本提供了关于产前药物暴露的独特信息。 胎粪在妊娠的第13周开始形成，毛发在妊娠的最后三个月开始形成。每个矩阵都提供了确定不同矩阵中药物浓度是否与孕产妇和新生儿结局指标相关的机会。此外，由于胎儿基质中药物浓度低，因此有必要开发灵敏和选择性的方法来检测这些化合物。正在改进分析方法，以提供更灵敏、更可靠的方法来检测各种产妇和婴儿样本中的阿片类药物的母体药物和代谢物，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。子宫内暴露后药物测量的分析挑战之一是新生儿样本中的药物和代谢产物谱可能与成人生物体液中的药物和代谢产物谱完全不同。这对于早产儿来说可能尤其如此。

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.