neonatal death associated with maternal methamphetamine abuse susan r. howe, phd joyce y. ho, bs...
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Neonatal Death Associated with Maternal Methamphetamine Abuse
Susan R. Howe, PhDJoyce Y. Ho, BSCarl Wigren, MD
December, 2006
Topics for Today
• Two cases of neonatal death– History of maternal methamphetamine use
• Children and methamphetamine
• Methamphetamine analysis in the lab
• Pathology of neonatal death with maternal methamphetamine use
What is Methamphetamine?
• CNS Stimulant
• Extremely addictive
• 6-8 hr high (or longer)
• Easy to produce
• Inexpensive
Pleasurable Effects
• Nearly immediate “flash” or “rush”
• Euphoria, alertness
• Increased energy
• Increased libido
Undesirable Effects• Used in “binge and crash” pattern• Leads to tolerance and abuse• Users forego food and sleep• Significant toxicity
– Increased heart rate – High blood pressure– Increase body temperature– Convulsions– Stroke– Death
Long Term Meth Use
• Violent behavior
• Psychotic symptoms
– Auditory hallucinations
– Mood disturbances
– Delusions and paranoia
• Changes to the brain
Current Perspective
National Drug Intelligence Center, 2005
Current Perspective
• 2005: 4.3% of US population > 12 has used methamphetamine
2005 National Survey on Drug Use and Health
• 2005: 4.5% of high school seniors have used methamphetamine
2005 Monitoring the Future Study, NIDA
Women and Meth
• 2003 Arrestee Drug Abuse Monitoring Program
– 4.7% of adult male arrestees test positive for meth at the time of arrest
– 8.8% of adult female arrestees test positive for meth at the time of arrest
Meth and Pregnancy• Infant Development, Environment, and
Lifestyle Study, 2006 (IDEAL)
– 5.2% of women have used meth at some time in their pregnancy
– Meth use during pregnancy associated with small birth weight babies
Meth and Pregnancy
• Fetal growth restriction– Long term effects?
• Ruptured placenta
• Preterm labor
• Disease (HIV, hepatitis)
• Poor prenatal care, nutrition
“Prenatal exposure to drugs of abuse is
the single largest preventable cause of
developmental compromise of American children today.”
Malanga and Kosofsky, Developmental Brain Research 147(1-2): 47-57, 2003
Compromised Parenting
• Neglect• Diverted resources• Physical/mental health problems• Lack of supervision• Access to meth and paraphernalia• Exposure to high risk population• Poor nutrition/living conditions• Poor preventive care/disease management
Meth Manufacture
• An excerpt from the Betty Cranker Cookbook:
“Take a pinch of red phosphorous, a smidgen of ephedrine, a dash of iodine and a skosh of lye. Add some distilled water and simmer for a few hours and hope it doesn’t explode and kill you.”
Number of Children Affected by Methamphetamine Labs
2002–2005
2002 2003 2004 2005
Child injured 11 25 13 11
Child killed 2 1 3 2
Children affected
3,660 3,682 3,088 1,647
Total injured/killed/affected
3,673 3,708 3,104 1,660
Meth Lab Hazards to Children
• Accidental methamphetamine ingestion
• Chemical and physical hazards
• Neglect and abuse
• Increased risk of accidents
Medical Examiner’s Case 1
• Hispanic Female admitted to hospital for
vaginal bleeding
• Emergency hysterectomy performed
after delivery
• Later pronounced at the hospital
Toxicology Report Case 1
• Aorta Blood Amphetamine TDX Positive
• Hospital Blood Amphetamine 33.7 ng/ml• Hospital Urine Amphetamine Positive• Hospital Blood Methamphetamine 109.0 ng/ml• Hospital Urine Methamphetamine Positive
Case 2Companion Case to Case No.1
• Full term fetal demise pronounced upon delivery
• Mother tested positive for Amphetamine Screen at the hospital
Toxicology Report Case 2
• Urine Amphetamine TDX Positive
• Aorta Blood Amphetamine 104.5 ng/ml• Urine Amphetamine Positive• Meconium Amphetamine 422.0 ng/ml• Aorta Blood Methamphetamine 299.2 ng/ml• Urine Methamphetamine Positive• Meconium Methamphetamine 1468.4 ng/ml
Case 3
• Full term stillborn infant delivered by cesarean section
• Mother had normal pregnancy
• Mother denied drug usage
• Urine drug screen on mother tested positive
Toxicology Report Case 3
• Urine Amphetamine TDX Positive• Aorta Blood Amphetamine 45.1 ng/ml• Urine Amphetamine Positive• Meconium Amphetamine 266.0 ng/ml• Aorta Blood Methamphetamine 235.5 ng/ml• Urine Methamphetamine Positive• Meconium Methamphetamine 1816.0 ng/ml
Chief Medical Examiner
Crime Lab Toxicology Human ID
DNA
Firearms
TraceEvidence
ForensicToxicology
Drug Chemistry
ForensicDentistry
Fingerprints
Anthropology/Radiology
Toxicology Laboratory Goals:
– assist the medical examiner in evaluating the role of toxicants as a determinant or contributory factor in the cause and manner of death
– aid law enforcement agencies in the investigation of criminal activities
TSQ
AMPHETAMINE/METHAMPHETAMINE CHROMATOGRAM
C:\Xcalibur\Data\AMPQCMIXOCT12 10/12/2006 1:20:37 PM
RT: 0.00 - 8.01
0 1 2 3 4 5 6 7 8Time (min)
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RT: 4.494.487AA: 13185356SN: 2922
RT: 4.444.444AA: 3113532SN: 3269
RT: 5.115.113AA: 18874303SN: 4607
RT: 5.105.099AA: 6151323SN: 9271
RT: 3.723.721AA: 18380772SN: 4931
RT: 5.155.149AA: 1990057SN: 1947
RT: 5.615.606AA: 7288093SN: 1526
RT: 3.463.464AA: 241049SN: 22
RT: 6.536.533AA: 32367SN: 9
NL: 9.23E5TIC F: + c ESI SRM ms2 [email protected] [ 91.121-91.123, 119.125-119.127] MS ICIS AMPQCMIXOCT12
NL: 2.19E5TIC F: + c ESI SRM ms2 [email protected] [ 96.099-96.101] MS ICIS AMPQCMIXOCT12
NL: 1.46E6TIC F: + c ESI SRM ms2 [email protected] [ 91.120-91.122, 119.126-119.128, 133.140-133.142] MS ICIS AMPQCMIXOCT12
NL: 4.79E5TIC F: + c ESI SRM ms2 [email protected] [ 92.119-92.121] MS ICIS AMPQCMIXOCT12
NL: 1.13E6TIC F: + c ESI SRM ms2 [email protected] [ 148.157-148.159] MS ICIS AMPQCMIXOCT12
NL: 1.68E5TIC F: + c ESI SRM ms2 [email protected] [ 135.061-135.063] MS ICIS AMPQCMIXOCT12
NL: 6.48E5TIC F: + c ESI SRM ms2 [email protected] [ 135.061-135.063] MS ICIS AMPQCMIXOCT12
AMPHETAMINE/METHAMPHETAMINE SPECTRAC:\Xcalibur\Data\AMPQCMIXOCT12 10/12/2006 1:20:37 PM
RT: 0.00 - 8.01
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RT: 4.494.487AA: 13185356SN: 2922
NL: 9.23E5
TIC F: + c ESI SRM ms2 [email protected] [ 91.121-91.123, 119.125-119.127] MS ICIS AMPQCMIXOCT12
AMPQCMIXOCT12 #1505 RT: 4.49 AV: 1 NL: 5.69E5F: + c ESI SRM ms2 [email protected] [ 91.121-91.123, 119.125-119.127]
91.122 91.123
m/z
119.125 119.126
m/z
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RT: 0.00 - 8.01
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me
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RT: 5.115.113AA: 18874303SN: 4607
NL: 1.46E6
TIC F: + c ESI SRM ms2 [email protected] [ 91.120-91.122, 119.126-119.128, 133.140-133.142] MS ICIS AMPQCMIXOCT12
AMPQCMIXOCT12 #1707 RT: 5.09 AV: 1 NL: 1.35E6F: + c ESI SRM ms2 [email protected] [ 91.120-91.122, 119.126-119.128, 133.140-133.142]
91.122
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119.126
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133.140
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91.12
119.13
133.14