Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure

Gwendolyn A McMillin; Anna W Morad; Jessica M Boyd; Kamisha L Johnson-Davis; Torri D Metz; Marcela C Smid; Matthew D Krasowski

doi:10.1093/clinchem/hvae018

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Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure

Journal article

Open access

Peer reviewed

Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure

Gwendolyn A McMillin, Anna W Morad, Jessica M Boyd, Kamisha L Johnson-Davis, Torri D Metz, Marcela C Smid and Matthew D Krasowski

Clinical chemistry (Baltimore, Md.), Vol.70(7), pp.934-947

07/2024

DOI: 10.1093/clinchem/hvae018

PMID: 38549034

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Abstract

Substance use during pregnancy is common, as is biological testing that is intended to help identify prenatal exposures. However, there is no standardized requirement for biological testing with either maternal or newborn specimens, nor is there standardization related to when testing occurs, how frequently testing occurs, what specimen(s) to test, what substances to test for, or how to perform testing. We review common specimen types tested to detect maternal and newborn substance exposure with a focus on urine, meconium, and umbilical cord tissue. We also review common analytical methods used to perform testing, including immunoassay, and mass spectrometry platforms. Considerations regarding the utilization of testing relative to the purpose of testing, the drug analyte(s) of interest, the specific testing employed, and the interpretation of results are emphasized to help guide decisions about clinical utilization of testing. We also highlight specific examples of unexpected results that can be used to guide interpretation and appropriate next steps. There are strengths and limitations associated with all approaches to detecting substance exposure in pregnant persons as well as biological testing to evaluate a newborn with possible substance exposure. Standardization is needed to better inform decisions surrounding evaluation of substance exposures in pregnant people and newborns. If biological sampling is pursued, testing options and results must be reviewed in clinical context, acknowledging that false-positive and -negative results can and do occur.

Details

Title: Subtitle: Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure
Creators: Gwendolyn A McMillin - University of Utah
Anna W Morad - Vanderbilt University Medical Center
Jessica M Boyd - University of Utah
Kamisha L Johnson-Davis - University of Utah
Torri D Metz - University of Utah
Marcela C Smid - University of Utah
Matthew D Krasowski - Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, United States
Resource Type: Journal article
Publication Details: Clinical chemistry (Baltimore, Md.), Vol.70(7), pp.934-947
DOI: 10.1093/clinchem/hvae018
PMID: 38549034
NLM abbreviation: Clin Chem
eISSN: 1530-8561
Language: English
Electronic publication date: 03/29/2024
Date published: 07/2024
Academic Unit: Pathology
Record Identifier: 9984577109902771

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