Prevalence of prenatal exposure to substances of abuse: questionnaire versus biomarkers

Abstract

Alcohol and drugs of abuse consumption in young adults, including women of childbearing age, has experienced significant increase over the past two decades. The use of questionnaires as the only measure to investigate prenatal alcohol and drugs of abuse exposure underestimates the real prevalence of exposure and could mislead to wrong conclusions. Therefore, the aim of this article was to compare reported rates of prenatal alcohol and drugs of abuse consumption with biomarkers of exposure by a comprehensive review of the available literature. We searched MEDLINE and EMBASE databases for articles catalogued between 1992 and 2015. We identified relevant published studies that assessed the comparison between prenatal exposure to alcohol and drugs of abuse assessed by self-reported questionnaire of consumption versus biomarkers of exposure. Thirteen studies were included regarding alcohol consumption, and seven of them about drugs of abuse. Women who admitted consumption during pregnancy by questionnaire varied from 0 to 37% for alcohol, from 0 to 4.3% for cocaine, and 2.9% for tetrahydrocannabinol (THC). Positive biomarkers results ranged from 16 to 44% for alcohol, 15.4% for cocaine, and from 4 to 12.4% for THC. Biomarkers should always complement questionnaires, as it has been shown that self-report may underestimate prenatal exposure to substances of abuse.

Adverse childhood experiences are associated with illicit drug use among pregnant women with middle to high socioeconomic status: Findings from the All Our Families Cohort

“…Data collected on maternal ACEs and illicit drug use in pregnancy were based on self-report. While retrospective reports of major, easily de ned ACEs have acceptable psychometric properties (60,61), illicit drug use in pregnancy is frequently underreported (5). We note that underreporting is particularly ampli ed in jurisdictions that have laws that penalize women for prenatal drug use (4-6), which was not the case for the present sample.…”

“…A 95% con dence interval (CI) was selected a priori given 1% to 6% of pregnant women report illicit drug use in community-based samples. Thus statistical power was expected to be low despite a moderately sized sample of 1,660 pregnant women, and use of a 99% CI may have resulted in a Type II error (1)(2)(3)(4)(5)(6)(7)(8). Missing data were handled using listwise deletion.…”

Adverse Childhood Experiences are Associated with illicit drug use among pregnant women with middle to high socioeconomic status: Findings from the All Our Families Cohort

“…This nding is comparable to surveys across jurisdictions that have found 1-5% of women report illicit drug use in pregnancy. [10][11][12][13][14][15][16] Within the present sample, maternal ACEs were common and associated with a two to four-fold increase in illicit drug use during pregnancy. A US study among young, single, low-income, African-American women found a strong dose-dependent association between maternal ACEs and illicit drug use in pregnancy.…”

“…[7][8][9] Across surveys, approximately 1-5% of women report illicit drug use in pregnancy, with biomarker research suggesting the actual prevalence is higher. [10][11][12][13][14][15][16] Illicit drug use has acute and long term toxic impacts on pregnant women and children due to exposure to the drug, the uncertainty of the dose being taken, and the contamination of illicit drugs with other substances and chemicals. 11,17−21 In Canada, fentanyl has been detected in the illegal drug supply country-wide across jurisdictions.…”

Focus sur le système endocannabinoïde et la reprotoxicité du cannabis chez la femme à l’heure du débat sur sa dépénalisation en France

“…Dans la revue de la litté rature de Chiandetti et al, 3 é tudes visaient à comparer les questionnaires par rapport aux biomarqueurs d'exposition au THC dans le liquide mé conial et les cheveux maternels. La pré valence de consommation autodé claré e é tait de 2,9 % et augmentait entre 4 à 12,4 % lorsqu'elle é tait é valué e par des biomarqueurs [31]. De même, dans une population de femmes enceintes d'un centre californien, la pré valence de consommation é valué e par les tests toxicologiques é tait deux fois plus é levé e que lorsqu'elle é tait auto-rapporté e [32].…”