Drug Positivity Findings from a Universal Umbilical Cord Tissue Drug Analysis Program in Appalachia

Background West Virginia has high rates of opioid-related health crises and deaths that extend to pregnant women and newborns. Our institutional screening approach has included universal umbilical cord tissue drug analysis (UCTDA) since 2013. The objective of this study was to retrospectively report incidence of in utero drug exposure using UCTDA data. Methods Two sequential UCTDA data sets (October 2013 to September 2015, and October 2016 to September 2018) represent interrupted epochs given changes in interfaced data availability. UCTDA positivity (by drug class and parent drug) and numbers of drugs detected in each specimen were retrospectively analyzed. THC was removed from the analysis because of discontinuous testing, and 4 opioids were separated from the data set given the potential for both therapeutic and illicit use. Results UCTDA specimens that were positive for drugs (22% overall) decreased between Epochs 1 and 2, from 25% to 20%. Increased positivity was noted for hydrocodone (+407%), oxycodone (+240%), amphetamines (+506%), and cocaine (+417%). Fentanyl and morphine positivity decreased by 75% and 18%, respectively, whereas buprenorphine detection increased 195%. Most positive specimens (80% overall) had 1 drug present, but specimens positive for 2 to 6 discrete drugs were found. Conclusion Universal UCTDA allows for unbiased assessment of drug exposure in infants. With the additional knowledge of therapeutic indications for drug use, UCTDA may allow for analysis of trends in illicit drug use and the impact of interventions to curb neonatal abstinence syndrome.