As part of a multicenter longitudinal study of prenatal cocaine and/or opiate (COC-OP) exposure and maternal/child outcomes, 4 clinical centers(Brown Univ., Univ. of Miami, Univ. of Tennessee, Memphis and Wayne State Univ.) screened 19,079 mothers, out of which 11,811 (70%) were eligible and consented. The cohort was 50% Black, 62% of the mothers were single, 63% on Medicaid and 7% of the infants were <33 weeks gestational age. Meconium was centrally analyzed using RIA (EMIT) screen with positive samples confirmed by GC/MS on 8,527 (72%) of the infants. Maternal self-report of drug use was collected from an in-hospital interview. Assays included 4 metabolites of COC(cocaine {A}, benzoylecgonine {B}, cocaethylene {C}, initially, with m-hydrobenzoylecgonine {D}, added midway through study) and 5 of OP (morphine{A}, codeine {B}, 6-monoacetylmorphine {C}, hydromorphone {D}, hydrocodone{E}).

For COC, the probability of positive GC/MS given a positive screen was.80. Of the mothers for which the infant's meconium was available, 642 (7.2%) reported using cocaine and 104 (1.1%) reported using opiates. Exposure to cocaine and/or opiates based on meconium or maternal report resulted in 938(10.7%) infants classified as exposed. The probability of a positive GC/MS given the maternal self-report was positive was.70. The probability of a positive GC/MS given the maternal self-report was negative was.03. We suggest the decision to use the “gold standard” of GC/MS may be more beneficial for research than for public health. Table

Table 1 GC/MS Confirmation of Positive Screens
Full size table

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