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 2002200320042005 Child injured11251311 Child killed2132 Children affected 3,6603,6823,0881,647 Total injured/killed/ affected 3,6733,7083,1041,660

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 BloodAmphetamine TDX Positive Hospital BloodAmphetamine 33.7 ng/ml Hospital UrineAmphetamine Positive Hospital BloodMethamphetamine 109.0 ng/ml Hospital UrineMethamphetamine Positive

27. Case 2 Companion 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 BloodAmphetamine104.5 ng/ml UrineAmphetaminePositive MeconiumAmphetamine422.0 ng/ml Aorta Blood Methamphetamine 299.2 ng/ml UrineMethamphetaminePositive MeconiumMethamphetamine1468.4 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 UrineAmphetamine TDXPositive Aorta BloodAmphetamine45.1 ng/ml UrineAmphetaminePositive MeconiumAmphetamine266.0 ng/ml Aorta BloodMethamphetamine235.5 ng/ml UrineMethamphetaminePositive MeconiumMethamphetamine1816.0 ng/ml

31. Chief Medical Examiner Crime Lab DNA Trace Evidence Firearms Toxicology Forensic Toxicology Drug Chemistry Human ID Forensic Dentistry Anthropology/ Radiology Fingerprints

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