Prenatal methamphetamine exposure and fetal death: A retrospective autopsy-based study

Methamphetamine use during pregnancy is an increasing public health concern with potentially severe consequences for fetal development and survival. This study aimed to evaluate the sociodemographic, autopsy, histopathological, and toxicological findings of fetal deaths with toxicologically confirmed postmortem methamphetamine detection.

This retrospective autopsy-based descriptive study included 28 fetal death cases referred from multiple regions across Türkiye and evaluated by the First Specialization Board of the Council of Forensic Medicine between 2020 and 2024. Cases were selected on the basis of methamphetamine detection in postmortem fetal blood together with forensic assessment of methamphetamine exposure/toxicity as a primary or contributory factor in death. Macroscopic autopsy findings were integrated with histopathological and toxicological analyses.

The mean gestational age was 29.11 ± 5.44 weeks, and 53.6% of cases were female. The mean maternal age was 29.85 ± 4.58 years; 78.6% of mothers were primigravida, and 78.6% lacked regular prenatal care. In 60.7% of cases, fetal expulsion or discovery occurred in the home setting. Small for gestational age was identified in 57.1% of cases. Histopathological findings included placental infarction (10.7%), chorioamnionitis (17.9%), funisitis (3.6%), and perinatal pneumonia (14.3%). Median postmortem fetal blood methamphetamine and amphetamine concentrations were 0.126 mg/L (IQR: 0.057-0.406) and 0.020 mg/L (IQR: 0.008-0.044), respectively.

Fetal deaths with toxicologically confirmed postmortem methamphetamine detection highlight the serious clinical and medicolegal consequences of substance use during pregnancy. The high frequency of inadequate prenatal care and home-based fetal expulsion or discovery underscores important gaps in the early identification and referral of vulnerable pregnant women and supports the need for coordinated obstetric, psychiatric/addiction, forensic, and social support pathways.