The Maternal Lifestyle Study: Drug use by meconium toxicology and maternal self-report

George Washington University, Washington, Washington, D.C., United States
PEDIATRICS (Impact Factor: 5.3). 03/2001; 107(2):309-17. DOI: 10.1542/peds.107.2.309
Source: PubMed

ABSTRACT The objective of this study was to describe drug use by pregnant women participating in the 4-site Maternal Lifestyle Study of in utero cocaine and/or opiate exposure.
Meconium specimens of 8527 newborns were analyzed by immunoassay with GC/MS confirmation for metabolites of cocaine, opiates, cannabinoids, amphetamines, and phencyclidine. Maternal self-report of drug use was determined by hospital interview.
The prevalence of cocaine/opiate exposure in the 4 sites was 10.7% with the majority (9.5%) exposed to cocaine based on the combination of meconium analysis and maternal self-report. However, exposure status varied by site and was higher in low birth weight infants (18.6% for very low birth weight and 21.1% for low birth weight). Gas chromatography/mass spectrometry (GC/MS) confirmation of presumptive positive cocaine screens was 75.5%. In the cocaine/opiate-exposed group, 38% were cases in which the mother denied use but the meconium was positive. There was 66% agreement between positive meconium results and positive maternal report. Only 2% of mothers reported that they used only cocaine during pregnancy and mothers were 49 times more likely to use another drug if they used cocaine.
Accurate identification of prenatal drug exposure is improved with GC/MS confirmation and when the meconium assay is coupled with a maternal hospital interview. However, the use of GC/MS may have different implications for research than for public policy. We caution against the use of quantitative analysis of drugs in meconium to estimate the degree of exposure. Our study also highlights the polydrug nature of what used to be thought of as a cocaine problem.

Download full-text


Available from: Marilyn A Huestis, Mar 26, 2014
    • "A history of maternal alcohol, marijuana, and nicotine use during the pregnancy was recorded during a hospital interview with the mother. These were considered background variables in both the exposed and unexposed groups (Lester et al., 2001). Self-reported cocaine , opiate, and other illicit drug use history was also obtained during the maternal interview. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This was a prospective longitudinal multisite study of the effects of prenatal cocaine and/or opiate exposure on temperament in 4-month-olds of the Maternal Lifestyle Study ( N = 958: 366 cocaine exposed, 37 opiate exposed, 33 exposed to both drugs, 522 matched comparison). The study evaluated positivity and negativity during The Behavior Assessment of Infant Temperament (Garcia Coll et al., 1988). Parents rated temperament (Infant Behavior Questionnaire; Rothbart, 1981). Cocaine-exposed infants showed less positivity overall, mainly during activity and threshold items, more negativity during sociability items, and less negativity during irritability and threshold items. Latent profile analysis indicated individual temperament patterns were best described by three groups: low/moderate overall reactivity, high social negative reactivity, and high nonsocial negative reactivity . Infants with heavy cocaine exposure were more likely in high social negative reactivity profile, were less negative during threshold items, and required longer soothing intervention. Cocaine- and opiate-exposed infants scored lower on Infant Behavior Questionnaire smiling and laughter and duration of orienting scales. Opiate-exposed infants were rated as less respondent to soothing. By including a multitask measure of temperament we were able to show context-specific behavioral dysregulation in prenatally cocaine-exposed infants. The findings indicate flatter temperament may be specific to nonsocial contexts, whereas social interactions may be more distressing for cocaine-exposed infants.
    Development and Psychopathology 06/2015; DOI:10.1017/S0954579415000504 · 4.89 Impact Factor
  • Source
    • "Further, we have previously shown that our self-report substance use measures, with careful interviewer selection and training and attention to question format, identified a higher percentage of users than did urine screening (Richardson et al., 1999, 2006). Other researchers have shown this as well (Ashling et al., 1994; Fendrich et al., 2004; Lester et al., 2001; Rutherford et al., 2000; Zuckerman et al., 1989). We did collect biological samples from the 21-year offspring and those data also support this point: 95% of those offspring with positive urine screens for marijuana reported current use. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Prenatal cocaine exposure (PCE) has been linked to child behavior problems and risky behavior during adolescence such as early substance use. Behavior problems and early substance use are associated with earlier initiation of sexual behavior. The goal of this study was to examine the direct and indirect effects of PCE on sexual initiation in a longitudinal birth cohort, about half of whom were exposed to cocaine in utero. Women were interviewed twice prenatally, at delivery, and 1, 3, 7, 10, 15, and 21 years postpartum. Offspring (52% female, 54% African American) were assessed at delivery and at each follow-up phase with age-appropriate assessments. At age 21, 225 offspring reported on their substance use and sexual behavior. First trimester cocaine exposure was a significant predictor of earlier age of first intercourse in a survival analysis, after controlling for race, sociodemographic characteristics, caregiver pre- and postnatal substance use, parental supervision, and child's pubertal timing. However, the association between PCE and age of first sexual intercourse was mediated by adolescent marijuana and alcohol use prior to age 15. Most of the effect of PCE on age of sexual initiation occurred between the ages of 13-18, when rates of initiation were approximately 10% higher among exposed offspring. This effect was mediated by early adolescent substance use. These results have implications for identification of the exposed offspring at greatest risk of HIV risk behaviors and early, unplanned pregnancy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 12/2014; 145:194-200. DOI:10.1016/j.drugalcdep.2014.10.011 · 3.28 Impact Factor
  • Source
    • "One of the difficulties in studying prenatal exposure effects is that a cluster of prenatal adversity factors associated with substance-dependent mothers typically act additively or interactively with opiate exposure, for example, polydrug use (Lester et al., 2001), psychiatric disease during pregnancy (Ponder et al., 2011), and poverty and stress (Harris & Seckl, 2011). Lester and coworkers have found deficits related to opiate exposure on the BSID but these were no longer significant when sociodemographic risk factors were controlled (Messinger et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Developmental features of the P2 auditory ERP in a change detection paradigm were examined in infants prenatally exposed to methadone. Opiate dependent pregnant women maintained on methadone replacement therapy were recruited during pregnancy (N = 60). Current and historical alcohol and substance use, SES, and psychiatric status were assessed with a maternal interview during the third trimester. Medical records were used to collect information regarding maternal medications, monthly urinalysis, and breathalyzer to confirm comorbid drug and alcohol exposures. Between birth and 4 months infant ERP change detection performance was evaluated on one occasion with the oddball paradigm (.2 probability oddball) using pure-tone stimuli (standard = 1 kHz and oddball = 2 kHz frequency) at midline electrode sites, Fz, Cz, Pz. Infant groups were examined in the following developmental windows: 4-15, 16-32, or 33-120 days PNA. Older groups showed increased P2 amplitude at Fz and effective change detection performance at P2 not seen in the newborn group. Developmental maturation of amplitude and stimulus discrimination for P2 has been reported in developing infants at all of the ages tested and data reported here in the older infants are consistent with typical development. However, it has been previously reported that the P2 amplitude difference is detectable in neonates; therefore, absence of a difference in P2 amplitude between stimuli in the 4-15 days group may represent impaired ERP performance by neonatal abstinence syndrome or prenatal methadone exposure. © 2013 Wiley Periodicals, Inc. Dev Psychobiol 9999: 1-10, 2013.
    Developmental Psychobiology 07/2014; 56(5). DOI:10.1002/dev.21160 · 3.16 Impact Factor
Show more