Accuracy in detecting prenatal drug exposure

A basic problem encountered by investigations of prenatal cocaine effects h as been the valid identification and quantification of exposure. Based on a combination of sources: (a) medical record review (b) maternal urine toxic ology screen, (c) meconium analysis, and (d) maternal postpartum interview drug exposure status of 415 infants was established Using this combination as a benchmark, maternal postpartum interview was found most sensitive, whi le medical record review was slightly less accurate. Meconium analysis and urine screens both demonstrated miss rates greater than the interview or re cord review methods. Meconium analysis and postpartum interview however, ea ch detected cases of cocaine exposure that the other had missed. Correlatio ns between the amount of cocaine found in meconium and in maternal report i ndicated that the cocaine metabolite benzoylecgonine was the best biologica l marker. Quantifying heavy versus light exposure required a combination of both meconium analysis and maternal postpartum interview techniques.