A wide range of maternal and fetal tissues are available for screening, including maternal and fetal blood, urine and hair, and neonatal meconium, as well as reproductive tissues such as placenta and umbilical cord. This leads to considerable uncertainty as to when testing should occur, which tests should be used, and how testing should be implemented. This is combined with a general absence of cooperation between scientists, who develop and validate these tests, and clinicians who use and interpret them. This has opened the debate regarding drug screening in pregnancy: who should be screened, by which methods, and how should these results be used?Ĭurrently, there are few validated and standardized tests for drug screening in pregnant women ( Grekin et al., 2010 Lam et al., 2015). While these laws were originally designed to protect the fetus, the fear instilled in women can prevent them from enrolling in treatment programs and accessing medical care throughout pregnancy. Certain US States including Alabama, South Carolina, and Tennessee have charged women who have taken drugs in pregnancy with child abuse and mothers who use illicit drugs are at high risk of losing custody of their newborns ( Young et al., 2007 Stone, 2015). Many women fear the consequences of using drugs in pregnancy, even if they cannot stop. However, self-reported studies regarding maternal substance use disorders have a high incidence of underreporting, due to fear and associated stigma ( Stone, 2015). Approximately 5% of women will admit to taking illicit drugs while pregnant ( Substance Abuse and Mental Health Services Administration, 2014). There are no specific guidelines for drug screening in pregnancy, and when combined with unreliable self-reporting, the true numbers of affected births are unknown. The prevalence of drug use in pregnancy is difficult to quantify. Since 1999, the incidence of NAS is estimated to have increased by over 300%, coinciding with the onset of today’s opioid epidemic ( Ko et al., 2016). Additionally, exposure may cause neonatal abstinence syndrome (NAS), in which the fetus develops symptoms of withdrawal following delivery ( Kocherlakota, 2014 Stover and Davis, 2015). ![]() In utero exposure to drugs puts the fetus at risk of premature delivery, physical, and cognitive developmental problems, and can increase the risk of neonatal mortality ( Chasnoff, 1988 Chasnoff et al., 1992 Stover and Davis, 2015). Within the wider population, pregnant women are not immune to substance use disorders and it is estimated over 10% of births in the United States each year are affected by illicit drug or alcohol use ( Wabuyele et al., 2018). Millions of people are affected by this epidemic, which does not discriminate by age, gender, race, geographic area, or socio-economic status ( Manchikanti et al., 2012 Metz et al., 2018). In the 21st century, North America has experienced an increase in the use of prescription and non-prescription opioids, so large and rapid that it has become an epidemic ( Okie, 2010 Metz et al., 2018). Balancing the scientific, medical, public health, legal, and ethical aspects of screening tests for drugs in pregnancy is critical for helping to address this crisis at all levels. However, women can and have been arrested for positive drug screens with even preliminary results used to remove children from custody, before rigorous confirmatory testing is completed. They also have great promise for public health monitoring, policy development, and resource allocation. Better screening tests have great potential to improve neonatal and maternal medical outcomes by enhancing the speed and accuracy of diagnosis. The drive for ever greater accuracy and sensitivity must be balanced with the necessities of medical practice requiring minimally invasive sampling, rapid turnaround, and techniques that can be realistically utilized in a clinical laboratory. Testing methods range from simple spectrophotometry and clinical chemistry to sophisticated analytical HPLC or mass spectrometry techniques. ![]() ![]() A wide range of tissues can be tested for drug use, including maternal blood, urine, and hair neonatal meconium, urine, and hair and placenta and umbilical cord tissues. The prevalence of drug misuse in pregnancy is not well quantified due to the lack of good validated tests, cooperation between clinicians and scientists developing tests, and consensus as to who should be tested and how results should be used. Pregnant women are not immune to the ravages of substance misuse which affects themselves, their pregnancies, and the wider community. North America is currently suffering from one of the worst epidemics of illicit drug use in recent history: the opioid crisis.
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