Accelerated fetal lung maturity profiles and maternal cocaine exposure

doi:10.1016/0029-7844(95)00353-3

Obstetrics & Gynecology

Volume 87, Issue 1, January 1996, Pages 128-132

https://doi.org/10.1016/0029-7844(95)00353-3 Get rights and content

Objective

To determine the effect of maternal cocaine exposure on fetal lung maturity as measured by surfactantalbumin ratios determined by the TDx-FLM test.

Methods

A case-control study design was used to compare fetal lung maturity as assessed by a surfactant-albumin ratio assay (TDx-FLM) in amniotic fluid (AF) obtained from women who were known to use cocaine and those who were not known to use cocaine during the study pregnancy. Multiple logistic regression procedures were used to control for gestational age and possible confounders, such as obstetric and nonobstetric complications, other substance abuse, race, infant sex, and payer status.

Results

Maternal cocaine use during pregnancy was associated with an accelerated fetal lung maturity profile (adjusted odds ratio [OR] 2.04, 95% confidence interval [CI] 1.04–4.00) as determined by the TDx-FLM test. Other variables found to be statistically significant predictors of a mature fetal lung profile were cigarette smoking during the current pregnancy (OR 1.61, 95% CI 1.02–2.56). Preterm labor, preterm rupture of membranes, nonobstetric illness during pregnancy, and exposure to other abused substances were not associated with accelerated fetal lung maturity.

Conclusion

Maternal cocaine use during pregnancy is associated with a doubling of the probability of a mature fetal lung profile as determined by TDx-FLM analysis of AF. Tobacco use is also a predictor of accelerated fetal lung maturity profiles.

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Identification and characterization of proteins in amniotic fluid that are differentially expressed before and after antenatal corticosteroid administration
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Citation Excerpt :
The novel observations reported in the current study provide interesting avenues for additional research. In addition to antenatal corticosteroid administration, a number of demographic factors and clinical conditions are associated also with enhanced fetal lung maturation, including female fetus,52 maternal race,53 preeclampsia,54 intrauterine exposure to cigarette smoke,55 cocaine,56 and intrauterine inflammation/infection,57-60 but not twins.61 Additional proteomic studies are needed to investigate further the AF proteome in each of these conditions to explain the observed difference in perinatal outcome.
We sought to examine changes in the intraamniotic proteomic environment after the administration of antenatal corticosteroids to women with impending preterm delivery.
Amniotic fluid samples were collected at the time of clinically indicated amniocentesis before and within 7 days of administration of antenatal corticosteroids for impending preterm delivery (n = 12). Proteins differentially expressed before and after corticosteroids were identified by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry. They were isolated, characterized, and quantified by fast protein liquid chromatography, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, in-gel tryptic digestion, immunodepletion assays, enzyme-linked immunosorbent assay, and electrospray ionization tandem mass spectrometry.
Five protein peaks of interest were identified and characterized, all of which were significantly decreased after antenatal corticosteroid administration. These included 2 isoforms of transthyretin, albumin, prothrombin fragment 2, and lumican.
Four proteins, identified and characterized in amniotic fluid, were differentially expressed with antenatal corticosteroid administration. These data may provide additional insight into the molecular mechanisms by which antenatal corticosteroids prevent neonatal complications.
Substance Abuse
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Cocaine in pregnancy: Recent data on maternal and fetal risks
1998, Obstetrics and Gynecology Clinics of North America
Cocaine abuse during pregnancy is a major health care problem demanding substantial obstetric and neonatal care and consuming scarce health care dollars. Data obtained in a rural, crack-using population in Florida demonstrated that the average total hospital charges for cocaine-exposed infants ($1,100,385) were almost three times the charges for unexposed infants matched for prenatal risk factors ($474,064). These additional costs are attributed to increased admission to the neonatal intensive care nursery, increased length of stay, and lower birth weight.⁵ Costs for the care of cocaine-exposed infants can be as much as 10 times the costs for a comparably matched urban control group.¹³ In addition to prematurity, cocaine creates several other health risks for both the pregnant woman and her fetus. This article reviews recent findings concerning the effects of prenatal cocaine use on the pregnant woman and her developing embryo and fetus. The reader is referred to earlier reviews for descriptions of previously observed effects of prenatal cocaine exposure on the fetus.57, 85, 89, 91, 136
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^*: This research was supported in part by a grant from the Mother's Aid Research Fund of the University of Chicago, Chicago. Illinois.

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Accelerated fetal lung maturity profiles and maternal cocaine exposure*

Objective

Methods

Results

Conclusion

Clin Perinatol

Am J Obstet Gynecol

Am J Obstet Gynecol

J Pediatr

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Drug use women. Establishing a standard of care

Ann N Y Acad Sci

Prevalence and magnitude of perinatal substance exposures in California

N Engl J Med

Testing for drugs of abuse. Pharmacokinetic considerations for cocaine in urine

Clin Pharmacokinet

Cocaine use in pregnancy

N Engl J Med

A new method for assessment of fetal lung maturity

Br J Obstet Gynaecol

Improved fluo-rescence polarization assay for use in evaluating fetal lung maturity. I. Development of the assay procedure

Clin Chem

Improved fluorescence polarization assay for use in evaluating fetal lung maturity: III. Retrospective clinical evaluation and comparison with the lecithin/sphingomyelin ratio

Clin Chem