A Retrospective Cohort Study Examining the Utility of Perinatal Urine Toxicology Testing to Guide Breastfeeding Initiation.

OBJECTIVE: National guidelines advise against breastfeeding for women who use nonprescribed substances in the third trimester. This reduces the number of women who are supported in breastfeeding initiation despite limited evidence on the prognostic value of third trimester substance use. We sought to examine the degree to which prenatal nonprescribed substance use is associated with non-prescribed use postpartum. METHODS: Retrospective cohort study of pregnant women with opioid use disorder on methadone or buprenorphine between 2006 and 2015. Nonprescribed use was defined by a positive urine drug testing (UDT). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated comparing 3 prenatal periods with postpartum UDT results. Generalized estimating equations were used to examine the extent to which prenatal nonprescribed use was associated with postpartum use. RESULTS: Included were 545 deliveries by 503 women. Mean age was 28.3 years, 88% were White/non-Hispanic, 93% had public insurance, and 43% received adequate prenatal care. The predictive value of UDT's 90 to 31 days before delivery, 30 to 0 days before delivery, and at delivery showed low sensitivity (44, 26, 27%, respectively) and positive predictive value (36, 36, 56%, respectively), but higher negative predictive value (80, 85, and 78%, respectively), P-values all <0.05. In the final adjusted model, only nonprescribed use at delivery was significantly associated with postpartum nonprescribed use. CONCLUSIONS: Nonprescribed use at delivery was most strongly associated with postpartum use compared with earlier time periods currently prioritized in guidelines. In women with opioid use disorder prenatal UDT results alone are insufficient to guide breastfeeding decisions.

A Rapid Response Electrochemical Biosensor for Detecting Thc In Saliva.

Marijuana is listed as a Schedule I substance under the American Controlled Substances Act of 1970. As more U.S. states and countries beyond the U.S. seek legalization, demands grow for identifying individuals driving under the influence (DUI) of marijuana. Currently no roadside DUI test exists for determining marijuana impairment, thus the merit lies in detecting the primary and the most sought psychoactive compound tetrahydrocannabinol (THC) in marijuana. Salivary THC levels are correlated to blood THC levels making it a non-invasive medium for rapid THC testing. Affinity biosensing is leveraged for THC biomarker detection through the chemical reaction between target THC and THC specific antibody to a measure signal output related to the concentration of the targeted biomarker. Here, we propose a novel, rapid, electrochemical biosensor for the detection of THC in saliva as a marijuana roadside DUI test with a lower detection limit of 100 pg/ml and a dynamic range of 100 pg/ml - 100 ng/ml in human saliva. The developed biosensor is the first of its kind to utilize affinity-based detection through impedimetric measurements with a rapid detection time of less than a minute. Fourier transform infrared spectroscopy analysis confirmed the successful immobilization of the THC immobilization assay on the biosensing platform. Zeta potential studies provided information regarding the stability and the electrochemical behavior of THC immunoassay in varying salivary pH buffers. We have demonstrated stable, dose dependent biosensing in varying salivary pH's. A binary classification system demonstrating a high general performance (AUC = 0.95) was employed to predict the presence of THC in human saliva. The biosensor on integration with low-power electronics and a portable saliva swab serves as a roadside DUI hand-held platform for rapid identification of THC in saliva samples obtained from human subjects.

Examination of Hospital, Maternal, and Infant Characteristics Associated with Breastfeeding Initiation and Continuation Among Opioid-Exposed Mother-Infant Dyads.

OBJECTIVES: Among opioid-exposed newborns, breastfeeding is associated with less severe withdrawal signs, yet breastfeeding rates remain low. We determined the extent to which hospital, maternal, and infant characteristics are associated with breastfeeding initiation and continuation among opioid-exposed dyads. MATERIALS AND METHODS: We examined breastfeeding initiation and continuation until infants' discharge among opioid-exposed dyads from 2006 to 2016. Among dyads meeting hospital breastfeeding guidelines, we assessed hospital (changes in breastfeeding guidelines and improvement initiatives [using delivery year as a proxy]), maternal (demographics, comorbid conditions, methadone versus buprenorphine treatment, and delivery mode), and infant (gestational age and birth weight) characteristics. We used multivariable logistic regression to examine independent associations of characteristics with breastfeeding initiation and continuation. RESULTS: Among 924 opioid-exposed dyads, 61% (564) met breastfeeding criteria. Overall, 50% (283/564) of dyads initiated and 33% (187/564) continued breastfeeding until discharge. Breastfeeding initiation and continuation rates increased from 38% and 8% in 2006, to 56% and 34% in 2016, respectively. In adjusted models, infants born after reducing restrictions in hospital breastfeeding guidelines and prenatal breastfeeding education (adjusted odds ratio, aOR 2.6 [95% confidence interval, CI 1.5-4.5]) had increased odds of receiving any maternal breast milk versus infants born with earlier hospital policies. Cesarean versus vaginal delivery (aOR 0.3 [95% CI 0.2-0.6]) and length of infant hospitalization (aOR 0.94 [95% CI 0.92-0.97]) were negatively associated with breastfeeding continuation. CONCLUSIONS: Despite increasing breastfeeding rates among opioid-exposed dyads, rates remain suboptimal. Hospital-level factors were the greatest predictor of breastfeeding initiation. The findings suggest that changes in hospital guidelines and initiatives can impact breastfeeding initiation among this vulnerable population.