Change in skin color.
Open in a separate window Among pregnant women 15—44 years of age, 3. This was significantly lower than the rate among non-pregnant women age 15—44 years 8. For example, cocaine is.
Methamphetamine is scary because it is the only illicit drug that does not have a lower rate for pregnant. For pregnant women in the 15—44 age group, 3. In the United States inthere were 3, births to women aged 15 to 44 years [ 11 ]. Using NHSDA estimates of substance use during pregnancy, the approximate numbers of births in complicated by maternal use of illicit drugs, tobacco, and alcohol were ,; ,; and , respectively [ 29 ].
Thus, from the public health perspective, the impact of substance use during pregnancy extends far beyond maternal health to that of a large number of the unborn population.
There is also overlap between licit and illicit drugs. From these estimates it has been suggested that approximately 1 million children each year are exposed to legal or illegal substances i.
MATID during gestation [ 31 ]. It is also important to point out that the NHSDA is based on self-report of drug use and therefore likely to underestimate the extent of prenatal drug exposure. Just as with other drugs, it is very difficult to isolate the true prevalence of prenatal cocaine use among pregnant women because prevalence rates are often dependent on self-reporting by the women.
In a study by Vega and colleagues in the early s, it was discovered that 1. The lack of true prevalence rates can also be attributed to the lack of focus on those groups that are considered to be "low-risk" for drug use, e.
There are groups considered high risk based upon patterns of use. Cocaine use is especially concentrated among poor women of color.
In the Vega et al. This figure became even more pronounced when looking at subgroups of poor women. Methods of identification of drug using women The accurate identification of prenatal drug exposure is important not only to understand the nature and magnitude of the problem, but also to determine appropriate medical and psychosocial intervention.
The prevalence of prenatal drug exposure is very difficult to estimate because of flaws in all methods of identification. Methods vary and include interview, self-administered questionnaires, intake history, urine testing of mother and infant, testing of infant hair and meconium first stool of the newborn.
Maternal self-report of drug use is problematic because of the fear of the consequences of admitting to the use of drugs such as Child Protective Services CPS involvement and the threat of child removal, or because it is socially unacceptable.
Self-report is also unreliable because of the inaccuracy of recall, especially when questions such as "when", "how often" and "how much" are asked. Under-reporting of drug use by pregnant women has been reported in several studies [ 34 - 37 ].
Infant biomarkers of in-utero exposure to illegal and legal drugs including cocaine, opiates, amphetamines, marijuana and nicotine, are available from different specimens.
Although urine has been the widely used specimen, increasing evidence suggests that meconium is preferable [ 3538 - 44 ]. For example, cocaine metabolites are measurable in urine for only 96— hours after the last cocaine use in contrast to meconium, which can detect cocaine use throughout the second half of pregnancy.
The primary metabolite of nicotine is cotinine and can be measured in urine and meconium. A recent assay has been developed for detecting alcohol in meconium using fatty acid ethyl esters [ 46 ]. Hair analysis can also be used to detect drugs, and like meconium has the advantage of reflecting more than recent use [ 47 ].
In addition to the choice of specimen, the accurate detection of prenatal drug exposure is influenced by the choice of initial screening test and use of a confirmation procedure.
Choice of metabolites can also affect accuracy of identification. We [ 34 ] used four metabolites for cocaine, and one of them, HBE, was the only metabolite found in of the cases.
Finally, some drugs are more difficult to detect than others. The advantage of using both drug toxicology and maternal self-report has been shown in several studies [ 3435374950 ].grupobittia.com is a free online community where intelligent minds from around the world come to debate online and read the opinions of others.
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