Substance Abuse in Pregnancy Issues in West Virginia

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Substance Abuse in PregnancyIssues in West
Virginia

• Stefan Maxwell M.D.
• Women Childrens Hospital
• Charleston W.V.

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Objectives

• Substances commonly used
• Methods of data collection
• What are our motives?
• Should we attempt to improve our information?

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Substances commonly used
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Substances commonly used
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Substances commonly used

• Of West Virginia women who reported using
  addictive drugs or alcohol during pregnancy
• 78 also reported they used tobacco

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Smoking in WV and USA
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Common Substances used

• Marijuana
• Cocaine and Methamphetamines
• Narcotics Heroin and Methadone
• Legal drugs Nicotine and Alcohol
• ?Others yet to be identified

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Other drugs

• Opiates and opiate-like substances
• --propoxyphene HCL (Darvon)
• --codeine
• --pentazocine (Talwin)
• Non-opiates
• --Barbiturates
• --Chlordiazepoxide, diazepam
• --Diphenhydramine, imipramine

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Other drugs

• Selective serotonin reuptake inhibitors (SSRIs)
• Paroxetine HCL (Paxil)
• Fluoxetine (Prozac)
• Citalopram HBr (Celexa)
• Sertraline HCL (Zoloft)
• Venlafaxine HCL (Effexor)

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Data collection

• Maternal history (unreliable)
• Maternal and newborn urine (unreliable)
• Newborn meconium (collection issues)
• Newborn hair (collection issues)
• Umbilical cord tissue

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What are our motives?

• Initially
• To address growing problem of illicit drug use.
  Collected data from chart reviews and then from
  birth score data. Data dependent on maternal
  history. Maternal screening tool (SB307) will
  help get more accurate data
• Evident now that nicotine and alcohol are more
  prevalent and ?more teratogenic than illicit drugs

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What are our motives?

• Suggest
• We need more accurate information to develop the
  maternal screening tool in order to start
  education and rehabilitation early in pregnancy
• Umbilical cord pilot study

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Umbilical cord tissue

• Universally available
• Rapid results
• ELISA (enzyme-linked immunosorbent assay) as
  reliable and less expensive than gold standard
  tandem mass spectrometry (JPerinatology,vol28,11)
  
• Anonymous epidemiologic screening tool

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Umbilical cord tissue
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Umbilical cord tissue
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IRB Protocol Non-Human subject research

• Collection of discarded specimens (umbilical cord
  segments) to test for substances of abuse
• Goal is to determine more exactly the rate and
  types of substances used during pregnancy in
  neonates delivered at WV Hospitals

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Cord tissue study

• Cord specimens de-identified labeled only by
  hospital of origin
• No consent required (WVU ORC)
• Specimens batched and sent to USDTL or other
  lab for cordstat 12 ETOH testing
• Results released when collection complete

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Cord tissue study

• Society may benefit from knowing the true
  incidence of substance abuse during pregnancy in
  West Virginia
• This information should help in developing a more
  focused maternal screening tool which will direct
  antenatal education and rehabilitation, and
  ultimately improve the health of our mothers and
  babies in the state.

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Summary

• Substances commonly used
• Methods of data collection
• Suggested a pilot study using discarded cord
  tissue specimens to more accurately determine the
  prevalence of certain drugs in this state
• Ultimately achieve our motives