May 18, 2017


Dr. Jones: The epidemic of substance abuse in the U.S. includes moms and the babies they carry. Can a baby be born addicted? And how can we find out so we can provide better care for the newborns? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Whatever you breathe, eat, smoke, inject or put on your skin when you're pregnant goes to your baby. Knowing this, most moms-to-be are very careful about what they put in their bodies. But some moms just don't know the risks to the baby of the drugs they are taking. And some moms can't help themselves and put dangerous substances into themselves and their fetuses.

When a baby is born, the baby is separated physically from the mom, the cord is cut, and the umbilical cord, which is baby tissue, is discarded. If we obstetricians or pediatricians are worried about what the baby might have been exposed to, what can we do? Sometimes moms will tell us, sometimes they won't, and sometimes they don't know.

Today in The Scope studio we're talking to Dr. Gwen McMillin. She's a professor of pathology and the medical director of toxicology at ARUP, which is our big national testing lab. She'll tell us how we can use umbilical cords to help us take better care of newborns at risk.

Welcome, Dr. McMillin. When it comes to babies being exposed to drugs of abuse during pregnancy, what's the scope of the problem? Big? Little? One in a million?

Dr. McMillin: Unfortunately, the problem is actually growing, and some of that is the recognition of how harmful both drugs of abuse and prescription drugs can be to a mother and the unborn baby. I think the incidence is estimated at about 10% right now, so about 10% of babies are thought to have been exposed to dangerous compounds in utero, and I would say that that problem is growing in parallel with the national opioid epidemic that most people are aware of.

Dr. Jones: Wow, one in 10. One in 10.

Dr. McMillin: Yes.

Dr. Jones: We do 4,000 births at the University Hospital here a year. One in 10 makes a lot of babies exposed to drugs. Well, so how do we figure out if babies have been exposed? What kind of samples are used?

Dr. McMillin: So the traditional specimens that have been evaluated to identify drug exposed infants have been hair, which not every baby has.

Dr. Jones: I got a baldy for sure.

Dr. McMillin: And the meconium which is the first stool of the newborn, or baby poop maybe, that most of us are familiar with. And the challenge with meconium is that it may take several days to pass. We have to be very aware of those passages and scrape the meconium out of the diapers. That can require sometimes several days, several passages and lots of people involved. So there can be lots of problems or errors associated with that. It also will take more time to get results from the laboratory about what might be inside that meconium or hair.

So, a few years ago, we recognized that problem and investigated the possibility of using the umbilical cord tissue itself, which as you pointed out is typically discarded but is a lifeline to the baby. So we found that if we actually grind up that tissue we can detect drugs and drug metabolites or breakdown products in that cord to identify those drug exposed infants. And of course, that's logistically the best specimen possible because every child has a cord and it's available right at birth.

Dr. Jones: Right. And taking it, it's not like having to stick the baby for blood or wait around for the baby to poop. It's right there as soon as the baby is separated from the mom and we can send it to you. So, how do doctors access this? Can you ask for it? Or is it just a research plan? Or how is this happening right now?

Dr. McMillin: Well, ARUP laboratories has been offering this test clinically for about three and half years. There are now two other laboratories in the US that also offer this type of testing.

Dr. Jones: Were you first?

Dr. McMillin: We were actually second. But that's a tough race.

Dr. Jones: To be the best.

Dr. McMillin: To be the very best, yes.

Dr. Jones: Yes, to be fastest.

Dr. McMillin: Yes, yes, yes. And so we offered it as a clinical test to our clients, which are primarily hospitals, and we found that more and more hospitals are now making this a routine part of their practice so that they go ahead and collect cords for every baby and then store it to find out whether or not the baby starts to exhibit signs and symptoms of drug withdrawal or whether there are other risk factors that would suggest drug testing would make sense.

Dr. Jones: Right. But at sometimes we use it for moms who came in addicted to drugs, but changed their behaviors for themselves and for their babies and were completely clean for their pregnancy and it makes a big deal for them and the way the social services look at their mom if the moms cord is clean, the baby's cord is clean.

Dr. McMillin: Absolutely, absolutely. A cord that is negative for drugs or drug metabolites does not definitively say that mom abstained from drugs during pregnancy because, of course, no drug test is perfect and no drug test can pick up everything. But for the most part, yes, it's a way for moms to help validate that they did change their behavior and did what they thought was best for their child.

Dr. Jones: Right. So, in terms of the sample, does it reflect what happened in the last 12 hours or 72 hours? How long does the toxin, does the opioid, or whatever drug might be stay in the cord that you might be testing?

Dr. McMillin: The actual detection limits vary a little bit based on the stability of the drug at physiological temperatures.

Dr. Jones: Well, that sounds like lab speak but I get it.

Dr. McMillin: Okay. So, yes. At physiological temperatures, which are warm. . .

Dr. Jones: Well, thank you.

Dr. McMillin: Some drugs don't stick around very long and breakdown, and so some drugs are hard to detect after a period of time when they're incubated, basically, by the mom and the baby. But research has been done thus far suggests that the umbilical cord tissue can detect drugs that are used during approximately the last trimester of a full-term birth. We can also pick up drugs that are administered during labor and delivery sometimes and that's because of contamination of the cord with mom's blood, but sometimes that's informative as well.

Dr. Jones: Right, and unless we have records of that?

Dr. McMillin: Yes.

Dr. Jones: So you know or you can ask the record . . .

Dr. McMillin: That's correct.

Dr. Jones: That the mom got during labor. Well, this is all important for us to take care of babies and to take care of moms. I think when babies are born and suffering symptoms that look like drug withdrawal, we need to have the tools to provide the best specific care for the newborn, and ARUP laboratories have given us new tools to help the babies and we'll try to create a better world for moms. And thanks for joining us and thank you, Gwen, for joining us on The Scope.

Dr. McMillin: Thank you for the opportunity.

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