Central and autonomic system signs with in utero drug exposure

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 87; no. 2; pp. F106 - F112
• Main Authors: Bada, H S, Bauer, C R, Shankaran, S, Lester, B, Wright, L L, Das, A, Poole, K, Smeriglio, V L, Finnegan, L P, Maza, P L
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-09-2002; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; National Library of Medicine - MEDLINE Abstracts
• Subjects: Adult; Alcohol; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; ANS; autonomic nervous system; Autonomic Nervous System Diseases - etiology; Biological and medical sciences; Central nervous system; Central nervous system diseases; Central Nervous System Diseases - etiology; Childrens health; CNS; Cocaine; Cocaine-Related Disorders; Complications and side effects; Confidence intervals; Drug use; Emergency and intensive care: neonates and children. Prematurity. Sudden death; EMIT; enzyme multiplied immunoassay technique; EXP; exposed; Exposure; Female; gas chromatography/mass spectroscopy; GC/MS; GEE; generalised estimating equations; gestational age; Heroin; Humans; in utero; Infant; Infants; Intensive care medicine; Maternal Lifestyle Study; Medical sciences; MLS; Mothers; Multivariate analysis; narcotic withdrawal syndrome; Narcotics; Nervous system; NON; non-exposed; opiate; Opioid-Related Disorders; Original; Pregnancy; Pregnancy Complications; Pregnant women; Prenatal Exposure Delayed Effects; Risk factors; Signs; Studies; Urine; Womens health; Human; Drug addiction; Statistical analysis; Alcoholism; Tobacco smoking; Clinical form; Opiates; Exposure; Medical screening; Pregnancy; Newborn; Mother; Diseases of the autonomic nervous system; Central nervous system disease; Fetus; Cocaine
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/fn.87.2.F106

Aims: To determine risk for central nervous system/autonomic nervous system (CNS/ANS) signs following in utero cocaine and opiate exposure. Methods: A multisite study was designed to determine outcomes of in utero cocaine and opiate exposure. A total of 11 811 maternal/infant dyads were enrolled. Drug exposed (EXP) infants were identified by maternal self report of cocaine or opiate use or by meconium testing. Of 1185 EXP, meconium analysis confirmed exposure in 717 to cocaine (CO) only, 100 to opiates (OP), and 92 to opiates plus cocaine (OP+CO); 276 had insufficient or no meconium to confirm maternal self report. Negative exposure history was confirmed in 7442 by meconium analysis and unconfirmed in 3184. Examiners masked to exposure status, assessed each enrolled infant. Using generalised estimating equations, adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated for manifesting a constellation of CNS/ANS outcomes and for each sign associated with cocaine and opiate exposure. Results: Prevalence of CNS/ANS signs was low in CO, and highest in OP+CO. Signs were significantly related to one another. After controlling for confounders, CO was associated with increased risk of manifesting a constellation of CNS/ANS outcomes, OR (95% CI): 1.7 (1.2 to 2.2), independent of OP effect, OR (95% CI): 2.8 (2.1 to 3.7). OP+CO had additive effects, OR (95% CI): 4.8 (2.9 to 7.9). Smoking also increased the risk for the constellation of CNS/ANS signs, OR (95% CI) of 1.3 (1.04 to 1.55) and 1.4 (1.2 to 1.6), respectively, for use of less than half a pack per day and half a pack per day or more. Conclusion: Cocaine or opiate exposure increases the risk for manifesting a constellation of CNS/ANS outcomes.