Drug Testing for Newborn Exposure to Illicit Substances in Pregnancy: Pitfalls and Pearls

Table 1

Possible effects on newborns due to illicit drug use in pregnancy (not a complete list).

Drug	Possible effects on the newborn
Stimulants:	Perinatal:
Methamphetamine, Cocaine….	Low birth weight [10–12] CNS irritability/lability of state [13–15] —crying, jittery, sleep/wake alterations may have continued exposure through breastfeeding Neurodevelopmental alterations [16] Necrotizing enterocolitis [17] (Teratogenicity suggested by case studies but not confirmed by larger cohort or animal studies) [18]
	Long term: Modest but measurable longitudinal differences of cocaine-exposed infants in growth [19, 20], cognition [21], language [22], and impaired behavioral self-regulation [23, 24]. Other risk and protective factors can moderate outcome [23–25]. Longitudinal cohort of amphetamine-exposed infants showed school and behavioral problems (but environment impacts as well) [26]. Longitudinal methamphetamine studies are underway [27].
Opiates/Opioids:	Perinatal:
Heroin, morphine, codeine, oxycodone, hydrocodone, meperidine, fentanyl, (and others)	Low birth weight [8, 9] Neonatal Abstinence Syndrome (NAS) [15, 28] scoring system available: (i) CNS irritability (ii) Autonomic dysfunction (iii) Respiratory symptoms (iv) GI disturbances
	Long term: Longitudinal studies limited, problems with behavioral self-regulation reported [27].
Cannabinoids:	Perinatal:
Marijuana	Low birth weight with heavy exposure [29] Lability of state [15]
	Long term: Impulsivity [8] and effects on executive functioning later in life [8, 30]
Hallucinogens:	Perinatal:
PCP, MDMA, LSD	Low birth weight [7, 8, 13] CNS irritability [13] Neurodevelopmental alterations [31]
	Long term: Longitudinal studies not available
Sedatives:	Perinatal:
Benzodiazepines, barbiturates	Low birth weight [32] Respiratory depression, Hypotonia [33]
	Long term: Longitudinal studies not available