Estimation of fetal exposure to drugs of abuse, environmental tobacco smoke, and ethanol

Many women worldwide use recreational drugs and alcohol. Details on the amounts and schedule of such exposures in pregnancy are often unreliable because of recall issues and shame and fears of legal action. Even when the report on maternal dose is correct, it does not necessarily reflect the amount reaching the fetus. Drugs of abuse accumulate in meconium and are incorporated into fetal hair on its growth. Recent work has documented the sensitivity and specificity of these assays for cocaine and other recreational drugs. Dose-response relationships between cocaine as measured in neonatal hair and head circumference or neurologic sequelae have been recently established. For ethanol, which cannot be measured in hair or meconium, accumulation of its fatty acid ethyl esters in meconium is emerging as a promising test for heavy maternal drinking in the second part of pregnancy. The identification of biologic markers of intrauterine exposure to xenobiotics will allow better understanding of etiology and dose-response relationships.