Introduction Periconceptual recreational drug use is associated with some fetal malformations, the aetiology of which is believed to be vascular disruption during organogenesis. The authors have extended our previous study using maternal hair root analysis which showed evidence of recreational drug use in 18% of women with a fetal gastroschisis, to other fetal malformations with a variety of aetiologies.

Methods In a multi-centre study, women with normal pregnancies (controls) and those with fetal abnormalities (cases) gave informed consent for analysis of drug metabolities in their hair using mass spectrometry, the gold standard technique for forensic hair analysis. Hair was cut at the root and tested in 3 cm sections to correspond to 3-month time periods. Cases and controls were age matched.

Results Of 506 women recruited, 85 (17%) had evidence of drug metabolites (amphetamines, barbiturates, benzodiazepine, cannabis, cocaine, ketamine, methamphetamine and opiates) in their hair. Cases with abnormalities such as gastroschisis, cleft lip and palate, renal, central nervous system (CNS) and cardiac anomalies were more likely to have evidence of drug exposure compared to controls (18% vs 15%). There was evidence of drug exposure in cases of genetic (aneuploidy, genetic syndrome 11%) or multifactorial aetiology (talipes, diaphragmatic hernia, exomphalos and neural tube disorders 19%).

Drug ingestion was highest in cases of gastroschisis (15/59, 25%), neural tube defects (7/25, 28%), talipes (7/27, 26%) and CNS defects (7/20, 35%).

Conclusion In addition to gastroschisis, a number of fetal abnormalities may be associated with taking recreational and other drugs that potentially disrupt vascular development.