Monitoring of drug intake during pregnancy by questionnaires and LC‐MS/MS drug urine screening: evaluation of both monitoring methods

Abstract

Various studies pointed towards a relationship between chronic diseases such as asthma and allergy and environmental risk factors, which are one aspect of the so-called Exposome. These environmental risk factors include also the intake of drugs. One critical step in human development is the prenatal period, in which exposures might have critical impact on the child's health outcome. Thereby, the health effects of drugs taken during gestation are discussed controversially with regard to newborns' disease risk. Due to this, the drug intake of pregnant women in the third trimester was monitored by questionnaire, in addition to biomonitoring using a local birth cohort study, allowing correlations of drug exposure with disease risk. Therefore, 622 urine samples were analyzed by an untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) urine screening and the results were compared to self-administered questionnaires. In total, 48% (n = 296) reported an intake of pharmaceuticals, with analgesics as the most frequent reported drug class in addition to dietary supplements. 182 times compounds were detected by urine screening, with analgesics (42%; n = 66) as the predominantly drug class. A comparison of reported and detected drug intake was performed for three different time spans between completion of the questionnaires and urine sampling. Even if the level of accordance was low in general, similar percentages (~25%, ~19%, and ~ 20%) were found for all groups. This study illustrates that a comprehensive evaluation of drug intake is neither achieved by questionnaires nor by biomonitoring alone. Instead, a combination of both monitoring methods, providing complementary information, should be considered.

Screening Pregnant Women and Their Neonates for Illicit Drug Use: Consideration of the Integrated Technical, Medical, Ethical, Legal, and Social Issues

“…However, there are a number of recognized agents which can cause false positive results (Moeller et al, 2008), and a MS method is recommended to confirm presence of a drug after a positive result from immunoassay. A screening study by Hoeke et al (2015) compared the results of questionnaires to an untargeted LC-MS/MS urine screen. The authors observed very low agreement between self-reported results and urine screens, between 19 and 25% (Hoeke et al, 2015).…”

“…A screening study by Hoeke et al (2015) compared the results of questionnaires to an untargeted LC-MS/MS urine screen. The authors observed very low agreement between self-reported results and urine screens, between 19 and 25% (Hoeke et al, 2015). In another study, urine samples were collected from neonates suspected to have been exposed to illicit drugs (Hon et al, 2016).…”

Assessment of maternal drug intake by urinary bio monitoring during pregnancy and postpartally until the third perinatal year

“…Antibacterial therapy during gestation or lactation was mainly performed by penicillin, macrolide, and lincosamide antibiotics, although low detection numbers were observed for these drugs, according to the study design and the dosing. However, as shown in a previous work using the identical 36th WOP samples and corresponding questionnaires, there is a huge discrepancy between reporting and detection of antibiotics in this setup . Antihypertensive therapy was guideline orientated using methyldopa or beta‐blockers instead of, for example, Ca 2+ ‐antagonists or ACE‐inhibitors during pregnancy or lactation …”

“…This method provides the most comprehensive LC–MS urine screening, which is available . However, to obtain the best information on drug utilization, a combined usage of all mentioned methods should be used …”

“…An alternative approach for assessment of drug intake is bio monitoring by, for example, hyphenated gas‐chromatography mass spectrometry or liquid‐chromatography–mass spectrometry (LC–MS) covering hundreds of different drugs. However, these methods only present information about (i) the covered compounds and (ii) a certain time period depending on the examined bio matrix, molecule properties, and metabolism …”