Intrauterine and Neonatal Exposure to Opioids: Toxicological, Clinical, and Medico-Legal Issues

Abstract

Opioids have a rapid transplacental passage (i.e., less than 60 min); furthermore, symptoms characterize the maternal and fetal withdrawal syndrome. Opioid withdrawal significantly impacts the fetus, inducing worse outcomes and a risk of mortality. Moreover, neonatal abstinence syndrome (NAS) follows the delivery, lasts up to 10 weeks, and requires intensive management. Therefore, the prevention and adequate management of NAS are relevant public health issues. This review aims to summarize the most updated evidence in the literature regarding toxicological, clinical, and forensic issues of intrauterine exposure to opioids to provide a multidisciplinary, evidence-based approach for managing such issues. Further research is required to standardize testing and to better understand the distribution of opioid derivatives in each specimen type, as well as the clinically relevant cutoff concentrations in quantitative testing results. A multidisciplinary approach is required, with obstetricians, pediatricians, nurses, forensic doctors and toxicologists, social workers, addiction specialists, and politicians all working together to implement social welfare and social services for the baby when needed. The healthcare system should encourage multidisciplinary activity in this field and direct suspected maternal and neonatal opioid intoxication cases to local referral centers.

Fetal and Infant Effects of Maternal Opioid Use during Pregnancy: A Literature Review including Clinical, Toxicological, Pharmacogenomic, and Epigenetic Aspects for Forensic Evaluation

“…The selection of the appropriate sample to analyze to detect opioid exposure in utero depends on sample availability and specific clinical or forensic considerations [ 75 ].…”

“…2018 [ 93 ]. Toxicological analyses: Bertaso et al 2023 [ 5 ], Pötsch et al 1999 [ 12 ], Bhatt-Mehta et al 2023 [ 15 ], Concheiro et al 2017 [ 32 ], de Castro et al2011 [ 33 ], López et al 2009 [ 44 ], Pandya et al 2023 [ 50 ], Ordean et al 2023 [ 51 ], Ostrea et al 2001 [ 52 ], Parikh et al 2011 [ 53 ], Robert et al 2007 [ 55 ], Ross et al2015 [ 56 ], Walhovd et al 2010 [ 62 ], Zedler et al 2016 [ 64 ], Zipursky et al 2021 [ 65 ], Albano et al 2023 [ 75 ], Kintz et al 2015 [ 76 ].…”

The Identification of Drug Abuse

“…Koželj and Prosen present data on the temperature-related degradation of tropanes atropine and scopolamine, highlighting the possible underestimation of GC/MS analysis in such tropane alkaloids as cases of the unintentional or intentional ingestion of plant material [ 9 ].…”