Neonatal Death Associated with Maternal Methamphetamine Abuse

1. Neonatal Death Associated with Maternal Methamphetamine Abuse Susan R. Howe, PhD Joyce Y. Ho, BS Carl Wigren, MD December, 2006

2. 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

3. What is Methamphetamine? • CNS Stimulant • Extremely addictive • 6-8 hr high (or longer) • Easy to produce • Inexpensive

4. Pleasurable Effects • Nearly immediate “flash” or “rush” • Euphoria, alertness • Increased energy • Increased libido

5. 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

9. Long Term Meth Use • Violent behavior • Psychotic symptoms • Auditory hallucinations • Mood disturbances • Delusions and paranoia • Changes to the brain

10. Current Perspective National Drug Intelligence Center, 2005

11. 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

12. 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

13. 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

14. Meth and Pregnancy • Fetal growth restriction • Long term effects? • Ruptured placenta • Preterm labor • Disease (HIV, hepatitis) • Poor prenatal care, nutrition

15. “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

16. 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

19. 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.”

21. Number of Children Affected by Methamphetamine Labs 2002–2005

22. Meth Lab Hazards to Children • Accidental methamphetamine ingestion • Chemical and physical hazards • Neglect and abuse • Increased risk of accidents

25. Medical Examiner’s Case 1 Hispanic Female admitted to hospital for vaginal bleeding Emergency hysterectomy performed after delivery Later pronounced at the hospital

26. 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

27. Case 2Companion Case to Case No.1 • Full term fetal demise pronounced upon delivery • Mother tested positive for Amphetamine Screen at the hospital

28. 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

29. 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

30. 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

32. 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

34. TSQ

35. AMPHETAMINE/METHAMPHETAMINE CHROMATOGRAM

36. AMPHETAMINE/METHAMPHETAMINE SPECTRA