The maternal lifestyle study: Drug use by meconium toxicology and maternalself-report

Objective. The objective of this study was to describe drug use by pregnant women participating in the 4-site Maternal Lifestyle Study of in utero coc aine and/or opiate exposure. Methods. Meconium specimens of 8527 newborns were analyzed by immunoassay w ith GC/MS confirmation for metabolites of cocaine, opiates, cannabinoids, a mphetamines, and phencyclidine. Maternal self-report of drug use was determ ined by hospital interview. Results. 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 me conium analysis and maternal self-report. However, exposure status varied b y 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 spectromet ry (GC/MS) confirmation of presumptive positive cocaine screens was 75.5%. In the cocaine/opiate-exposed group, 38% were cases in which the mother den ied use but the meconium was positive. There was 66% agreement between posi tive meconium results and positive maternal report. Only 2% of mothers repo rted that they used only cocaine during pregnancy and mothers were 49 times more likely to use another drug if they used cocaine. Conclusion. Accurate identification of prenatal drug exposure is improved w ith GC/MS confirmation and when the meconium assay is coupled with a matern al hospital interview. However, the use of GC/MS may have different implica tions for research than for public policy. We caution against the use of qu antitative 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.