Episode Transcript
Dr. Jones: Ten years ago, our clinics were filled with moms doing meth when they were pregnant and it broke my heart, but times have changed and drugs have changed, and we're going to talk about the drugs we unfortunately send to our babies when we're pregnant today on The Scope. 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: So, as we think about the drug epidemics that we're facing now in this country, we think about heroin, and we think about opioids, but I grew up in the era of cocaine, not personally, of course, and so clearly there have been some changes, and it's important because babies that are exposed to these drugs in utero withdraw differently, and some drugs last much longer. So we need to know what's available to the moms, what are moms taking these days, so that we can best take care of the baby. So today in The Scope Studio, we're talking with Dr. Gwen McMillin who is Professor of Pathology and Medical Director of Toxicology at ARUP Laboratories, which is our big national testing lab.
Thanks for joining us, Dr. McMillin.
Dr. McMillin: Happy to be here.
Dr. Jones: So tell me a little bit. You and I are of an age where we've seen things come and go in popularity in the drug business, but what have you been seeing in laboratories from substances that came with the baby after the baby was born? What were babies exposed to?
Dr. McMillin: Well, you're right. Drug use patterns have changed over time, and they are also geographically distributed, so some drugs are more popular in some parts of the country than others.
Dr. Jones: Can you give me an example of that?
Dr. McMillin: So I know that in San Diego, California, for example, methamphetamine was a very, very large problem. That has somewhat abated, and now I would say cannabis or THC-containing products are probably a much bigger problem.
Dr. Jones: Okay. So how about here in Utah? Have you seen a change over the last handful of years? I know we have . . . when people come, women who are pregnant come into our clinic, and we always ask about drugs that they might be using, I think things have changed, if they'll tell us.
Dr. McMillin: Definitely. The opioid epidemic that is affecting many people in this nation has also affected people in Utah, and a larger number of pregnant women are using prescription opioids like oxycodone or hydrocodone. If those moms are treated during pregnancy, then sometimes the drug is switched to one that may be safer, such as buprenorphine. Buprenorphine has recently been accepted as probably the safest opioid replacement for pregnant women.
Dr. Jones: And is it safer for the baby?
Dr. McMillin: It seems to be. There are studies that have shown that the likelihood of a withdrawal syndrome and the severity of that withdrawal syndrome seems to be less with a buprenorphine-exposed baby than with a methadone-exposed baby, or certainly with heroin and the prescription opioids like oxycodone and hydrocodone.
Dr. Jones: So there are reasons for mothers to be truthful.
Dr. McMillin: Absolutely.
Dr. Jones: We've done a Scope on being truthful to your doctor. Be truthful about what they're taking so they might actually have some changes made in the way they're cared for during their pregnancy that might help them and their baby, and it's also important for them to know what the consequences might be for them. So what are we seeing if about 1 in 10 -- that's a big number -- 1 in 10 babies are exposed to drugs of abuse or drugs in this state which might be abused, because it's certainly legal in Colorado in terms of cannabis? So what kinds of things were you seeing in ARUP? ARUP has samples from all over the country, right?
Dr. McMillin: Correct, yes. We receive roughly 50,000 specimens a day from all 50 states.
Dr. Jones: Wow! But that's not 50 baby specimens?
Dr. McMillin: No, no, not that many baby specimens, but we are doing thousands a month of umbilical cord tissue and meconium testing.
Dr. Jones: Okay, specifically to test to see if the baby's been exposed?
Dr. McMillin: Yes.
Dr. Jones: So what are you finding?
Dr. McMillin: So the most common drugs that we are finding are cannabis, as you might expect, so THC-containing drugs, and opioids. And, of the opioids, we do see quite a bit of buprenorphine, methadone, oxycodone, hydrocodone, and then some fentanyl, or meperidine, and sometimes heroin.
Dr. Jones: Wow! So, in terms of cannabis, let's talk of that a little bit, I think because it's legal, people think it won't have any effects on their pregnancy, or it's safe. We know that alcohol, which is legal, is not good for babies, and women largely abstain from alcohol. We know that nicotine, which is legal, is bad for babies, but I'm not sure we've got the word out so much on marijuana.
Dr. McMillin: Right. It is a controversial topic that's the subject of extensive research in many places. I'm aware of quite a bit of research going on in Colorado, for example, right now where mothers are queried about their cannabis use patterns during pregnancy, and both meconium and umbilical cord tissue are tested to help us understand what the extent of the deposition of these different cannabis compounds looks like and what that might mean to babies.
Dr. Jones: Well, so we don't necessarily want to feed these drugs to our babies when they're in our tummies, because then when they are removed from us, we're not going to . . . it's hard to smoke a joint when you're just a newborn. I couldn't get my kid to blow his nose until he was two. It just was too hard for him. We don't want to deliver these drugs to our babies through breast milk. Do you ever test breast milk?
Dr. McMillin: We actually do not test breast milk, and that's because it varies during a feeding, and so to do a good job, one would have to collect all of the breast milk from a feeding, mix it up and then test a portion of that, and even that is just a snapshot based on what mom was doing just prior to the collection, so it's not very informative. But we do use the results of the umbilical cord and meconium testing to help counsel a mother on whether she should be breastfeeding or not, and that's because we know that the THC-type compounds actually concentrate . . .
Dr. Jones: That's the marijuana kinds of compounds.
Dr. McMillin: Yes, the psychoactive compounds in marijuana tend to concentrate in the breast milk, and so maybe several-fold higher in concentration in the breast milk than they are in the blood, which, of course, would potentially expose the baby to a dangerous amount of these drugs.
Dr. Jones: Well, we know that some of the withdrawal symptoms are different, so babies withdrawing from methamphetamines might behave a little bit differently than babies withdrawing from opioids, but some babies withdraw for a long time. It takes a long time for them to get over that. Can you talk to that at all?
Dr. McMillin: Well, yes. Unfortunately, most babies don't get exposed to just one drug, so usually if a mother is using drugs during pregnancy, she's likely to use multiple drugs, and the withdrawal symptoms will look different for exposures to multiple drugs in combination. The timing, as you mentioned, is also variable because, for the withdrawal symptoms to be precipitated, the drug actually has to be eliminated sufficiently that the baby's body needs that drug or wants that drug, and will respond in such a way to solicit that drug.
Dr. Jones: Okay, so let's put it in common terms. If a baby wants the drug, what will the baby be doing? So what does a baby do when it wants its breast milk drug? It cries, it gets irritable, it wags its head around looking for a breast. So what do babies do when they're looking for their marijuana drug or their . . .?
Dr. McMillin: Irritability is a major sign and symptom. There's some well-characterized cries, shrieks, if you will, that suggest a baby is needing drug. There may be seizures which, of course, are really scary. And so, yeah, the baby will get very restless, their vital signs will ramp, so heart rate, temperature, and, you know, it's a pretty characteristic syndrome that . . .
Dr. Jones: That makes it really hard for a new mom, who is having her own sleep disturbances, and may not be at the top of her game, to have a baby who's really hard to soothe, because the breast isn't going to be enough to soothe that baby.
Dr. McMillin: Right. So the ideal scenario is that that these babies who are going through drug withdrawals get identified in the hospital before they go home so they can get appropriate treatment. And, in fact, many of these babies are admitted to neonatal intensive care units and treated with things like morphine, or phenobarbital, or melatonin to help them curb the need, and then they're weaned over days to weeks so that they can go home safely.
Dr. Jones: So what we want is the best for our moms, we want the best for our babies to be, and our best when our babies are born. So, to paraphrase Grace Slick, some pills, some drugs make you larger and some drugs make you small, but the ones you take when you're pregnant should be nothing at all. But thank you, all, for joining us on The Scope.
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