OBJECTIVE: 

Our primary objective was to estimate statewide prenatal substance exposure based on umbilical cord sampling. Our secondary objectives were to compare prevalence of prenatal substance exposure across urban, rural, and frontier regions, and to compare contemporary findings to those previously reported.

METHODS: 

We performed a cross-sectional prevalence study of prenatal substance exposure, as determined by umbilical cord positivity for 49 drugs and drug metabolites, through the use of qualitative liquid chromatography-tandem mass spectrometry. All labor and delivery units in Utah (N=45) were invited to participate. Based on a 2010 study using similar methodology, we calculated that a sample size of at least 1,600 cords would have 90% power to detect 33% higher rate of umbilical cords testing positive for any substance. Deidentified umbilical cords were collected from consecutive deliveries at participating hospitals. Prevalence of prenatal substance exposure was estimated statewide and by rurality using weighted analysis.

RESULTS: 

From November 2020 to November 2021, 1,748 cords (urban n=988, rural n=384, frontier n=376) were collected from 37 hospitals, representing 92% of hospitals that conduct 91% of births in the state. More than 99% of cords (n=1,739) yielded results. Statewide, 9.9% (95% CI 8.1–11.7%) were positive for at least one substance, most commonly opioids (7.0%, 95% CI 5.5–8.5%), followed by cannabinoid (11-nor-9-carboxy-delta-9-tetrahydrocannabinol [THC-COOH]) (2.5%, 95% CI 1.6–3.4%), amphetamines (0.9%, 95% CI 0.4–1.5), benzodiazepines (0.5%, 95% CI 0.1–0.9%), alcohol (0.4%, 95% CI 0.1–0.7%), and cocaine (0.1%, 95% CI 0–0.3%). Cord positivity was similar by rurality (urban=10.3%, 95% CI 8.3–12.3%, rural=7.1%, 95% CI 3.5–10.7%, frontier=9.2%, 95% CI 6.2–12.2%, P=.31) and did not differ by substance type. Compared with a previous study, prenatal exposure to any substance (6.8 vs 9.9%, P=.01), opioids (4.7 vs 7.0% vs 4.7%, P=.03), amphetamines (0.1 vs 0.9%, P=.01) and THC-COOH (0.5 vs 2.5%, P<.001) increased.

CONCLUSION: 

Prenatal substance exposure was detected in nearly 1 in 10 births statewide.

中文翻译：

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犹他州通过脐带采集和药物测试来估计产前物质暴露情况

 客观的：

我们的主要目标是根据脐带取样来估计全州范围内的产前物质暴露情况。我们的次要目标是比较城市、农村和边境地区产前物质暴露的流行率，并将当前的研究结果与之前报告的结果进行比较。

 方法：

我们通过使用定性液相色谱-串联质谱法，对 49 种药物和药物代谢物的脐带阳性进行了产前物质暴露横断面流行率研究。犹他州所有待产单位（N=45）均受邀参加。根据 2010 年使用类似方法的研究，我们计算出至少 1,600 根脐带的样本量将有 90% 的功效检测出脐带任何物质呈阳性的比率高出 33%。未识别的脐带是从参与医院的连续分娩中收集的。使用加权分析对全州和农村地区的产前物质暴露率进行了估计。

 结果：

从 2020 年 11 月到 2021 年 11 月，从 37 家医院收集了 1,748 条脐带（城市 n=988，农村 n=384，边境 n=376），占该州 91% 分娩医院的 92%。超过 99% 的绳索 (n=1,739) 取得了结果。全州范围内，9.9%（95% CI 8.1–11.7%）至少一种物质呈阳性，最常见的是阿片类药物（7.0%，95% CI 5.5–8.5%），其次是大麻素（11-nor-9-carboxy-delta） -9-四氢大麻酚 [THC-COOH]) (2.5%, 95% CI 1.6–3.4%)、安非他明 (0.9%, 95% CI 0.4–1.5)、苯二氮卓类药物 (0.5%, 95% CI 0.1–0.9%)、酒精（0.4%，95% CI 0.1–0.7%）和可卡因（0.1%，95% CI 0–0.3%）。农村地区的脐带阳性率相似（城市=10.3%，95% CI 8.3–12.3%，农村=7.1%，95% CI 3.5–10.7%，前沿=9.2%，95% CI 6.2–12.2%， P =.31 ）并且没有因物质类型而异。与之前的研究相比，产前接触任何物质（6.8 vs 9.9%， P =.01）、阿片类药物（4.7 vs 7.0% vs 4.7%， P =.03）、安非他明（0.1 vs 0.9%， P =.01） ) 和 THC-COOH (0.5 vs 2.5%, P <.001) 增加。

 结论：

全州近十分之一的新生儿检测到产前物质暴露。