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Meconium testing for cocaine metabolite: prevalence, perceptions, and pitfalls
S S Rosengren1, D B Longobucco, B A Bernstein
1Department of Pediatrics, Saint Francis Hospital and Medical Center, Hartford, Connecticut.
American Journal of Obstetrics and Gynecology
|May 1, 1993
Summary
Prenatal cocaine use affects 3.4% of newborns, correlating with maternal factors and leading to smaller infant size. Nurse assessments of cocaine use were unreliable.
Area of Science:
- Perinatal health
- Neonatal toxicology
- Maternal-fetal medicine
Background:
- Prenatal substance exposure is a significant public health concern.
- Understanding the prevalence and impact of prenatal cocaine use is crucial for targeted interventions.
- Existing data may not fully represent diverse urban and suburban populations.
Purpose of the Study:
- To determine the prevalence of prenatal cocaine use in a mixed urban/suburban sample.
- To correlate prenatal cocaine use with maternal demographics and newborn measurements.
- To evaluate the accuracy of clinical judgment in identifying prenatal cocaine exposure.
Main Methods:
- Meconium samples from 621 newborns were analyzed for benzoylecgonine.
- Maternal and infant characteristics were anonymously linked to meconium assay results.
- Statistical analyses included t-tests, Fisher's exact test, Duncan's multiple range analysis, and ANCOVA (p < 0.05).
Main Results:
- Benzoylecgonine, a cocaine metabolite, was detected in 3.4% of meconium samples (>0.1 µg/mL).
- Prenatal cocaine exposure showed significant statistical correlations with various maternal and neonatal characteristics.
- A nurse's clinical opinion correctly identified cocaine use in only 22% of cases.
Conclusions:
- Prenatal cocaine use is associated with multiparity, multigravidity, late/clinic-based prenatal care, public assistance, nonwhite race, and lower academic achievement.
- Infants exposed to cocaine in utero were significantly smaller, with size correlating strongly with nonwhite background.
- Clinical assessment by nurses is an unreliable method for predicting maternal cocaine use.