# Using umbilical cord tissue to identify prenatal ethanol exposure and co-exposure to other commonly misused substances

## TL;DR

This study uses umbilical cord tissue to detect prenatal ethanol exposure and finds that many cases also involve other substance misuse.

## Contribution

A new method using LDTD-MSMS to detect ethanol biomarkers in umbilical cord tissue is introduced.

## Key findings

- 1.8% of umbilical cord specimens showed evidence of prenatal ethanol exposure.
- 58% of ethanol-exposed specimens also showed co-exposure to other substances.
- Self-reported substance use during pregnancy is likely under-reported.

## Abstract

Substance misuse during pregnancy can result in a variety of poor pregnancy outcomes. Objective data reporting the prevalence of neonates born with ethanol metabolites (evidence of prenatal ethanol exposure) in their fluids or tissues are limited.

A secondary analysis of umbilical cord tissue specimens received for routine toxicological analysis was conducted. Prevalences of ethyl glucuronide (EtG), a long-term direct ethanol biomarker, were determined using a new laboratory tool, LDTD-MSMS. Additionally, other commonly misused substances were determined using routine procedures.

Of 12,995 specimens, 238 (1.8%) specimens contained EtG. Concentrations of EtG ranged from 5 ng/g to 6679 ng/g (median 47 ng/mg; IQR: 16 ng/g, 203 ng/g). Of those 238 EtG-positive specimens, nearly 58% (N = 138) contained additional substances or metabolites.

Self-report of substance use during pregnancy is under-reported. We have demonstrated co-exposure of substances with ethanol is higher than previous reports.