TITLE:
Using Umbilical Cord Tissue to Identify Prenatal Exposure to Fentanyl and Other Commonly Abused Drugs
AUTHORS:
Shanthi Hariharan, Donna Coy, Joseph Jones
KEYWORDS:
Fentanyl, Norfentanyl, Umbilical Cord, Neonatal Abstinence Syndrome, NAS, Newborn Toxicology, Prenatal Drug Exposure, Polysubstance Abuse
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.5,
May
31,
2022
ABSTRACT: Background: Prenatal exposure to fentanyl may lead to Neonatal Abstinence Syndrome
(NAS), a constellation of symptoms observed when newborns begin withdrawing
from addictive substances such as opioids. The use of umbilical cord tissue
segments (UC) for newborn toxicology has been increasing due to its apparent
long detection window, sensitivity, and ease of collection. However, very
little has been reported in the literature concerning the prevalence of in utero exposure to fentanyl and
co-exposure with other commonly abused substances. Specific aim: The
specific aims of this retrospective study are twofold. We will report
prevalence of neonatal exposure to fentanyl for a nationwide high-risk
population using UC submitted to a national reference laboratory for routine
forensic toxicology analysis and the co-exposure patterns observed for these
fentanyl-exposed neonates. Methods: A secondary analysis was performed
using historical data for UC received between January 1, 2020 and December 31,
2020 for routine forensic toxicology analysis. Results: During the study
period, our laboratory received 23,104 UC for analysis and 9667 (41.8%) of
those UC were positive for at least one drug. The prevalence of fentanyl
detection was 1.9% (n = 429). Of these 429 specimens there were 407 UC where
both fentanyl and norfentanyl were detected. There were 14 UC where only
fentanyl was detected and 8 UC where only norfentanyl was detected. When
detected, the median concentrations of fentanyl and norfentanyl were 4029 pg/g
(IQR: 1696, 9230 pg/g) and 10,756 pg/mg (IQR: 3925, 25,288 pg/g), respectively.
Of the 429 positive fentanyl and/or norfentanyl UC, 33 (7.7%) were only
positive for fentanyl and/or norfentanyl. Of the 396 polypositive UC, morphine
was the highest co-exposure with 243 UC (56.6%) being positive for both
fentanyls and morphine. The second most prevalent co-exposure observed was
methamphetamine/amphetamine (n = 173; 40.3%) followed by cannabinoids (n = 113;
26.3%) and benzoylecgonine (cocaine metabolite; n = 106; 24.7%). Conclusions: Nonmedical use of fentanyl is an alarming trend in this country including this
maternal demographic reported here. Fentanyl was typically found with other
commonly abused substances.