Umbilical Cord Tissue: A Better Way to Test for Prenatal Drug Exposure?

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Maureen A. O’Reilly, DNP, NNP-BC

Clinicians are searching for quicker and easier collection methods and more accurate toxicology testing for infants affected by intrauterine substance exposure. Umbilical cord testing offers some striking advantages over the “gold standard” of meconium testing, making the switch to cord testing increasingly attractive.

Pregnancy and Drugs of Abuse

Women in their reproductive years are at high risk for substance use disorder.[1] Unfortunately, many women continue unhealthy and addictive substance use behaviors throughout their pregnancies.[2] In a 2012 national survey,[2]5.9% of pregnant women admitted to illicit drug use, 8.5% drank alcohol, and 15.9% smoked cigarettes.[2] The opioid crisis and increased substance use in pregnancy have triggered a national debate,[3] politicizing both detection and treatment for women and their infants. This mix of politics, money, science, and social opinion pressures healthcare clinicians to constantly re-examine how they detect and treat substance use in pregnancy.

The Impact on Newborns

As many as 400,000-440,000 newborns (10%-11% of all births) are exposed to tobacco, alcohol, or illicit drugs each year.[4] In-utero substance exposure is associated with birth defects, premature delivery, fetal alcohol spectrum disorders, and developmental, behavioral, and cognitive problems in affected children.[5,6]

Neonatal abstinence syndrome is a disorder of central and autonomic nervous and gastrointestinal systems that occurs when intrauterine substance exposure causes the newborn to experience withdrawal after birth.[7] Rapid, accurate newborn toxicology testing is crucial in identifying affected newborns, allowing timely initiation of treatment.

Toxicology Testing Matrices

Meconium toxicology has long been the “gold standard” in detecting newborn exposure to drugs of abuse.[8,9] Meconium samples can be difficult to collect. Fetal stressors during labor or delivery can induce meconium passage,[6] or it can be delayed up to a week, depending on gestational age.[9,10] Alternatively, meconium may be passed but not collected because drug use is neither suspected nor reported until after the sample is no longer available, or a parent may discard a diaper with meconium to avoid illicit drug detection.[10]

Other sample matrices for newborn testing have drawbacks. Cutting a hair sample from a newborn is protested by parents for cosmetic reasons and frequently results in inadequate sample size.[6] Fingernails are small and inadequate for sampling in newborns.[6] Vernix caseosa can be used to detect maternal drug use after 24 weeks of gestation; however, the volume is often inadequate for testing.[6] The window of drug detection in urine is narrow.[9]Newborns often void at the time of birth and may not void again for hours. Furthermore, urine samples can be difficult to obtain in the newborn.[11]

A New Method: Umbilical Cord Toxicology

Dianne Montgomery, a neonatal nurse practitioner, was debating the pros and cons of various tissues and waste products for drug detection in newborns, while also trying to address nursing complaints about sample collection difficulties. She approached the United States Drug Testing Laboratory in 2001 to suggest the umbilical cord as an alternative tissue for infant toxicology.[11]Cord toxicology testing first became available commercially in 2012 and is now offered by several US laboratories.[12]

References:

  1. Forray A. Substance use during pregnancy. F1000Res. 2016;5.
  2. Reitan T. Substance abuse during pregnancy: a 5-year follow-up of mothers and children. Drugs Educ Prev Policy. 2018 Feb 15. [Epub ahead of print]
  3. Bodenner C. How to treat pregnant drug addicts? Your thoughts. Atlantic. May 21, 2015. Source Accessed May 4, 2018.
  4. National Center on Substance Abuse and Child Welfare. Substance-exposed infants: state responses to the problem. January 31, 2018. Source Accessed May 4, 2018.
  5. Interrante JD, Ailes EC, Lind JN, et al; National Birth Defects Prevention Study 1997-2011. Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997-2011. Ann Epidemiol. 2017;27:645-653. Abstract
  6. Wabuyele SL, Colby JM, McMillin GA. Detection of drug-exposed newborns. Ther Drug Monit. 2018;40:166-185. Abstract
  7. McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med. 2016;375:2468-2479. Abstract
  8. Colby JM. Comparison of umbilical cord tissue and meconium for the confirmation of in utero drug exposure. Clin Biochem. 2017;50:784-790. Abstract
  9. Concheiro-Guisan A, Concheiro M. Bioanalysis during pregnancy: recent advances and novel sampling strategies. Bioanalysis. 2014;6:3133-3153. Abstract
  10. Montgomery DP, Plate CA, Jones M, et al. Using umbilical cord tissue to detect fetal exposure to illicit drugs: a multicentered study in Utah and New Jersey. J Perinatol. 2008;28:750-753. Abstract
  11. United States Drug Testing Laboratory. CordStat origin with Dianne Montgomery . September 20, 2013. Source Accessed May 4, 2018.
  12. United States Drug Testing Laboratory. Umbilical cord drug tissue testing. Source Accessed May 6, 2018.
  13. Plate C. Identifying alcohol exposed newborns. United States Drug Testing Laboratory. 2012. Source Accessed May 8, 2018.
  14. Marin SJ, Christensen RD, Baer VL, Chantry CJ, McMillin GA. Nicotine and metabolites in paired umbilical cord tissue and meconium specimens. Ther Drug Monit. 2011;33:80-85. Abstract
  15. Wright TE, Milam KA, Rougee L, Tanaka MD, Collier AC. Agreement of umbilical cord drug and cotinine levels with maternal self-report of drug use and smoking during pregnancy. J Perinatol. 2011;31:324-329. Abstract
  16. ARUP Consult®. Newborn drug testing – meconium and umbilical cord tissue. SourceAccessed May 7, 2018.
  17. McMillin GA, Wood KE, Strathmann FG, Krasowski MD. Patterns of drugs and drug metabolites observed in meconium: what do they mean? Ther Drug Monit. 2015;37:568-580. Abstract
  18. ARUP Laboratories. Drug detection panel, umbilical cord tissue, qualitative. SourceAccessed May 8, 2018.
  19. United States Drug Testing Laboratory. Universal umbilical cord collection chain of custody procedure. Source Accessed May 9, 2018.
  20. Hudak ML, Tan RC; COMMITTEE ON DRUGS; COMMITTEE ON FETUS AND NEWBORN; American Academy of Pediatrics. Neonatal drug withdrawal. Pediatrics. 2012;129:e540-e560. Abstract
  21. American College of Obstetricians and Gynecologists. Opioid use and opioid use disorder in pregnancy. ACOG Committee Opinion 711. August 2017. Source Accessed May 10, 2018.
  22. Palmer KL, Wood KE, Krasowski MD. Evaluating a switch from meconium to umbilical cord tissue for newborn drug testing: a retrospective study at an academic medical center. Clin Biochem. 2017;50:255-261. Abstract
  23. Cotten SW. Drug testing in the neonate. Clin Lab Med. 2012;32:449-466. Abstract

 

Cite this article: Umbilical Cord Tissue: A Better Way to Test for Prenatal Drug Exposure? – Medscape – Jun 05, 2018.

Retrieved from https://www.medscape.com/viewarticle/897494

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