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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.034 Byline: Lisa O'Brien (a)(b), Carina Baumer (c), Detlef Thieme (c)(d), Hans Sachs (c)(d), Gideon Koren (a)(b)(e) Keywords: Pregnancy; Antidepressant metabolism; Hair; Segmental analysis Abstract: Depression and other psychiatric illnesses are common during pregnancy and are often treated with antidepressants. Physiological changes of pregnancy may alter the pharmacokinetics of medications and ultimately affect the dose required to maintain effective therapy. Human hair offers a safe, non-invasive way to monitor long term systemic exposures to medications. Author Affiliation: (a) Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Canada (b) Institute of Medical Science, University of Toronto, Canada (c) Forensic Toxicological Centre, Munich, Germany (d) Institute of Forensic Medicine, Munich, Germany (e) Department of Pediatrics, Hospital for Sick Children, Toronto, Canada Article History: Received 5 June 2009; Accepted 12 August 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.044 Byline: Xavier Joya (a)(b)(c), Mitona Pujadas (d)(e), Maria Falcon (f), Ester Civit (d), Oscar Garcia-Algar (a)(c)(g), Oriol Vall (a)(c)(g), Simona Pichini (h), Aurelio Luna (f), Rafael de la Torre (d)(e)(i) Keywords: Placenta; Prenatal exposure; Drugs of abuse; Interruption of pregnancy; Gas chromatography-mass spectrometry Abbreviations: MDMA, 3,4-methylenedioxymethamphetamine; AP, amphetamine; BEC, benzoylecgonine; BUP, buprenorphine; COC, cocaine; COT, cotinine; [DELTA]-9-THC-COOH, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol; EI, electron-impact; FAEEs, fatty acid ethyl esters; GC/MS, gas chromatography-mass spectrometry; ISTDs, internal standards; LOD, limit of detection; LOQ, limit of quantification; LC/MS/MS, liquid chromatography-tandem mass spectrometry; MA, methamphetamine; MOR, morphine; NIC, nicotine; MSTFA, N-Methyl-N-(trimethylsilyl)tri-fluoroacetamide; NBUP-Gluc, norbuprenorphine glucuronide; QC, quality control; SIM, selected-ion-monitoring; SPE, solid phase extraction; SD, standard deviation Abstract: We describe the development and validation of a method for the quantification of drugs of abuse, using gas chromatography-mass spectrometry (GC/MS), in human placenta. Concentration ranges covered were 5-500ng/g for amphetamine, methamphetamine, MDMA, methadone, cocaine, benzoylecgonine, cocaethylene, morphine, 11-nor-9-carboxy-delta-9-tetrahydrocannabinol, nicotine, and cotinine. Intra-assay and inter-assay imprecisions were less than 15.7% for lower quality control samples and less than 14.9% for medium and high quality control samples. Recovery range was 36.2-83.7%. Placenta samples were kept at -80[degrees]C until analysis; analytes were stable after three freeze-thaw cycles (samples stored at -20[degrees]C). This accurate and precise assay has sufficient sensitivity and specificity for the analysis of specimens collected from women who voluntarily terminated their pregnancy at 12th week of gestation. The method has proven to be robust and accurate for the quantification of the principal recreational drugs of abuse in this period of the prenatal life. This is the first report that highlights the presence of drugs of abuse during the first trimester of gestation. Author Affiliation: (a) Unitat de Recerca Infancia i Entorn (URIE), Institut Municipal d'Investigacio Medica - Hospital del Mar, Barcelona, Spain (b) Departament de Bioquimica i Biologia Molecular, Universitat AutA[sup.2]noma de Barcelona, Barcelona, Spain (c) Red de Salut Materno-Infantil y del Desarrollo (SAMID), Instituto Carlos III, Spain (d) Grup de Recerca en Farmacologia Humana i Neurociencies, Institut Municipal d'Investigacio Medica-Hospital del Mar, Barcelona, Spain (e) CIBER Fisiopatologia de la Obesidad y Nutricion, Instituto Carlos III, Spain (f) Departamento de Medicina Forense, Universidad de Murcia, Murcia, Spain (g) Departament de Pediatria, Obstetricia i Ginecologia i Medicina Preventiva, Universitat AutA[sup.2]noma de Barcelona, Barcelona, Spain (h) Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanita, Rome, Italy (i) Departament de Ciencies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain Article History: Received 18 July 2009; Accepted 15 September 2009

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.forsciint.2009.12.042 Byline: M. Falcon (a), F. Valero (a), M. Pellegrini (b), M.C. Rotolo (b), G. Scaravelli (b), J. Joya (c), O. Vall (c), O. Garcia Algar (c), A. Luna (a), S. Pichini (b) Keywords: Drug abuse; Pregnancy; Induced abortion Abstract: Drug abuse is a worldwide phenomenon with significant health and socioeconomic impact and it is of particular concern in women of reproductive age and in pregnant women. We aimed to investigate the prevalence of drug use by serum and hair testing in a cohort of pregnant women at 12th week gestation who decided voluntarily to interrupt their pregnancy and to investigate the relationship between drug exposure and induced abortions (IA), repeated IA and contraception. The study was conducted in an obstetrics clinic authorised to perform IA in Murcia, Spain during an 18 months period (2007-2009). Apart from serum and/or hair testing, the 142 women enrolled in the study completed a detailed questionnaire regarding drug, alcohol and tobacco use in the previous 3 months. Serum and hair samples were analyzed by gas chromatography mass spectrometry assays. Hair and serum samples showed a 30% overall positivity to drugs of abuse. Of these samples, 20.4, 14.1, 4.2 and 1.4% were positive for cannabinoids, cocaine, opiates, and MDMA, respectively, with polydrug use in 5.6% cases. In this cohort, a positive association was found between drug use and repeated IA. The results highlight the need for promoting pregnancy planning for young women in general, especially when consuming psychoactive substances as well as promote safe and accessible contraception in women of reproductive age. In women requesting IA, specific drug abuse counselling should be implemented. Author Affiliation: (a) Legal Medicine, University of Murcia, Spain (b) Istituto Superiore di Sanita, Rome, Italy (c) Paediatric Service, URIE, Hospital del Mar, and Universitat AutA[sup.2]noma, Barcelona, Spain Article History: Received 17 June 2009; Accepted 25 July 2009

Previous research has found an association between childhood and adult physical and sexual abuse and substance abuse, but has not examined or compared specific dimensions of the abuse experience. such as its age of onset or the type, severity, or frequency. Women receiving perinatal care (N = 1189) at an inner-city hospital clinic were systematically questioned about their lifetime and current cocaine use and experiences of abuse. We found an association between a history of abuse in childhood and lifetime and current cocaine use, as well as physical and sexual abuse during childhood and pregnancy. There was no difference in the rates of cocaine use between women whose onset of abuse was in childhood versus adulthood. Childhood sexual abuse (alone or in combination with physical abuse) was more associated with lifetime cocaine use than was physical abuse alone. Cocaine use was related to the severity, but not the frequency of abuse. Keywords - childhood abuse; cocaine; pregnancy; sexual abuse.

This paper presents evaluation results of a CSAP-funded case management project associated with an outpatient substance abuse treatment (SAT) program for women and their children. Key findings are: (a) case management and threat of child protective services encourage retention in SAT during pregnancy, (b) retention in SAT has a positive effect on reducing illicit substance use, (c) receiving methadone during pregnancy has a negative effect on reducing illicit substance use, and (d) reduction in illicit substance use has a positive effect on birth weight. These findings indicate retention in SAT and decreased illicit drug use are associated with improved infant birth weight, which is associated with other improvements, such as decreased infant mortality and morbidity. The finding of a relationship between methadone maintenance treatment (MMT) and illicit drug use creates' a dilemma for practice: to what extent should the dose of methadone be decreased during pregnancy, given the fact that women may then increase illicit use of drugs. Keywords - prenatal substance use: birth weight; case management; women and children's substance abuse programming; methadone maintenance.

Pregnant and postpartum substance-using women are a special population whose needs do not reflect those of the general substance-using communities. This study examined length of stay in a federally funded day treatment demonstration program in order to identify predictor variables that may help identify pregnant and postpartum substance-using women at high risk for dropping out of treatment. Variables from intake and exit questionnaires on a sample of 163 women were analyzed using multiple regression on both days in treatment and the logarithmic transformation of days in treatment. Few predictor variables were identified, although findings suggest that if a woman is younger and self-referred, she may leave treatment sooner. As one of the first sets of published data on pregnant and postpartum women and retention in treatment, this study lays the groundwork for future research on the retention of pregnant and postpartum women in treatment, thereby facilitating the success of these women in overcoming their addiction. Keywords - retention; dropout; substance abuse; drug abuse; pregnant.

I. Introduction As the use of illicit drugs persists as a major social problem facing urban America, the clinical evidence linking prenatal exposure to illicit drugs, in particular cocaine, and [...]

Recent reports estimate that 5 million U.S. women of childbearing age use illicit substances [1]. The effects of maternal substance abuse to both mother and child have become a major […]

Medical literature concerning drug abuse during pregnancy provides conflicting information about the long-term effects of drug exposure to the fetus while in the womb. Several studies with different research angles are discussed. Researchers still do not have an estimate for the number of drug-exposed infants born each year in the US. The best estimates are from a few locations such as New York City and Rhode Island. The immediate and long-term effects of drug exposure have been difficult to analyze since addicted pregnant women typically do not obtain prenatal care. The effect of drug abuse on fetal development also is uncertain. Researchers are investigating the effect of drugs on animal fetal development. More in-depth research is needed to determine the overall effect of drug exposure on infant development and on strategies for the treatment of drug-exposed children.

A comparison study was made between treated and untreated pregnant and postpartum cocaine-abusing women. The untreated women were less socially impaired with fewer symptoms of psychosocial distress. Thus, severity of psychosocial distress may be an important motivating factor in enrolling in a drug treatment program. However, the lack of childcare programs and social stigma attached to substance abuse in pregnancy may prevent pregnant and postpartum women from seeking drug treatment.

Alcohol and other drug use during pregnancy represents a major public health concern. This article characterizes a sample of 240 pregnant opioid- or cocaine-dependent women enrolled in the initial residential component of a comprehensive substance abuse treatment program for pregnant women. Data were collected using the Addiction Severity Index, Psychosocial History Form, and Structured Clinical Interview for DSM-III-R. Patients' substance use history, psychiatric comorbidity, social support network, employability, current and previous pregnancies, child custody arrangements, and the father of the current pregnancy, are described to assist providers in tailoring treatment to the specific needs of this population. Keywords: Pregnant women; Drug treatment; Treatment needs; Substance abuse; Child custody

Aetiological fractions are often used as an indirect measure of morbidity and mortality related to a specific risk factor. Aetiological fractions previously used in Australia for cocaine-related antenatal haemorrhage and low birth weight newborns have relied on risk ratios calculated from US-based studies. As outlined in this paper, there are several differences in the use and prevalence of cocaine and its associated harms between the two nations. As such, it is recommended that any use of these aetiological fractions with Australian data should occur with caution. Keywords: Australia, United States, cocaine, low birth weight. doi: 10.1111/j.1753-6405.2008.00262.x: