Introduction: Substance abuse in pregnancy is of serious concern to society as well as health care providers caring for pregnant women and their infants. Various studies have suggested a prevalence of 10 -20%. This study used anonymous sampling of umbilical cord tissue to estimate the prevalence of substance abuse in West Virginia. Methods: For the period of August 2009, as many umbilical cord samples as possible were collected at 8 regionally diverse hospitals in West Virginia. The cord tissue samples were then assayed for amphetamines, cocaine, opiates, marijuana, benzodiazapines, methadone, buprenorphine and alcohol. Results: 146 of 759 collected (19.2%) were positive for drugs or alcohol. The regional diversity in drug and alcohol consumption was striking, as was the absence of cocaine, methamphetamine and buprenorphine. Voluntary reporting on birth certificates and other maternal questionnaires underestimated the prevalence by 2-3 fold. Conclusion: One in five infants born in West Virginia has a significant drug exposure that is not captured by conventional reporting instruments. It is hard to estimate the societal and financial cost since so many infants are exposed.
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