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Foundational Research

Heavy in utero ethanol exposure is associated with the use of other drugs of abuse in a high-risk population

Shor S, Nulman I, Kulaga V, Koren G. Alcohol.
First Published: 21 December 2009   DOI: 10.1016/j.alcohol.2009.08.008


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Many ethanol dependent women also use other drugs of abuse that may affect pregnancy outcome and long-term child neurodevelopment. This study investigated the association between drugs of abuse and concurrent use of ethanol in pregnancy. A study cohort of neonates with FAEE levels above 2 nmol per gram meconium, indicative of heavy in utero ethanol exposure, was identified (n=114). Meconium and hair analyses for the presence of other drugs of abuse were obtained for some of these neonates and the rates of drug exposure were compared with the rates in a cohort of neonates who were tested negative (FAEE below 2 nmol per gram meconium) for ethanol exposure (n=622). Odds ratios (ORs) for various drugs were calculated with ethanol exposure. A 15.5% positive rate for intrauterine ethanol exposure was detected. A high rate of in utero drug exposure was detected in neonates with and without in utero ethanol exposure, 60.5% versus 62.7% respectively. Neonates with heavy in utero ethanol exposure were almost twice as likely to be exposed to narcotic opiates (OR=1.90; 95% confidence interval [CI]: 1.13-3.20) and 3.3 times as likely to be exposed to amphetamine (OR=3.30; 95% CI 1.06-10.27) when compared to neonates with no ethanol exposure. Exposure to cannabinoids predicted less likely exposure to ethanol (OR=0.61; 95% CI: 0.38-0.98) and no significant difference was noted in the exposure to cocaine (OR=1.24, 95% CI: 0.81-1.91). Neonates suspected of heavy in utero ethanol exposure should be tested for other drugs of abuse and vice versa. Early detection of drug exposures can facilitate early intervention to both the neonate and the mother, thus decreasing the risk of long-term neurodevelopmental outcomes for the child, including secondary disabilities associated with fetal alcohol spectrum disorder.

Patients and methods

All the neonatal meconium and hair analyses performed by the Motherisk Laboratory at The Hospital for Sick Children between June 1997 and July 2008 were reviewed. All the samples were collected by either Children’s Aid Societies or physicians who suspected intrauterine drug exposures and were sent to Motherisk Laboratory for clinical testing. The criteria for suspicion included personal or third-party reports, evidence of alcohol, and/or drug abuse.

Neonates who were tested for intrauterine


Nine hundred and forty three neonates were tested for intrauterine ethanol exposure using meconium FAEE measurements. There were 207 cases of insufficient meconium quantity for FAEE analysis; these cases were excluded from the statistical calculation. Out of the 736 cases with meconium FAEE results, 114 were positive results and 622 were negative, resulting in a 15.5% positivity rate for heavy in utero ethanol exposure.

In addition to FAEE testing documenting ethanol exposure, neonates were most 


The rates of illicit drug exposure of 60.5% and 62.7% for neonates with heavy in utero ethanol exposure and those without, respectively, were much higher than that reported in previously published studies where illicit drug use in Canadian women was estimated at 9.4% (Tjepkema, 2004). This can be explained by the fact that this study has focused on high-risk obstetric population where suspicion for drugs of abuse was the impetus for the test. And although the rate of in utero drug exposure was


This work was supported by a grant from the Canadian Institutes for Health Research. Gideon Koren is the holder of the Ivey Chair in Molecular Toxicology, Department of Medicine, University of Western Ontario.

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