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Am J Perinatol
DOI: 10.1055/a-2624-3880
Original Article

Frequency of Fentanyl-Adulterated Street Drugs Consumed by Mothers with Substance Use: The Value of Umbilical Cord Testing

Divya Rana 
1   Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
,
Linda DeBaer
1   Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
,
Massroor Pourcyrous
1   Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
2   Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, Tennessee
3   Department of Physiology, The University of Tennessee Health Science Center, Memphis, Tennessee
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Funding None.
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Abstract

Objective

Reports indicate that street drugs are frequently adulterated with fentanyl. However, standard urine drug toxicology may not detect fentanyl, and neonates with prenatal fentanyl exposure often experience severe withdrawal. This study aimed to determine the frequency of fentanyl-adulterated street drugs consumed by mothers with substance use disorders (SUD) using umbilical cord tissue toxicology (UCT).

Study Design

This retrospective observational study (2020–2022) analyzed mothers with SUD and their neonates, utilizing UCT to confirm fentanyl exposure. Additionally, we compared maternal characteristics between those who acknowledged fentanyl use during pregnancy and those who did not, along with neonatal outcomes.

Results

Among 353 infants born to 342 mothers with opioid use, 21.8% (77/353) had in-utero fentanyl exposure confirmed by UCT. Notably, 54% (40/74) of mothers in the fentanyl-positive group did not acknowledge fentanyl use. However, these mothers more frequently reported using other substances, including marijuana (p < 0.01) and cocaine (p < 0.03), suggesting fentanyl adulteration in street drugs. Umbilical cord fentanyl concentrations were similar between groups, though variance was higher among those who did not report fentanyl use, indicating potential inconsistent exposure. No significant differences were observed in neonatal characteristics.

Conclusion

Our study highlights the high frequency of prenatal fentanyl exposure due to adulterated street drugs used by mothers. Although the infant's characteristics and the severity of NOWS were similar in both groups, long-term outcomes may depend on UCT fentanyl concentrations. Therefore, umbilical cord drug screening is a crucial tool for detecting fetal exposure to fentanyl and appropriate neonatal assessment and intervention.

Key Points

  • Fentanyl, a potent synthetic opioid, is increasingly found in street drugs, often unbeknownst to users.

  • Mothers struggling with substance use may be exposed to illicit fentanyl without their knowledge.

  • Umbilical cord testing is crucial for identifying substance exposures in newborns.

  • Newborn assessment and treatment can differ and impact their short- and long-term outcomes.

Keywords

maternal opioid use - neonatal opioid withdrawal - self-report of fentanyl use in pregnancy

Ethical Approval

This study was approved by the Institutional Review Board of the University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee. Approval to waive consent was also obtained.


Authors' Contributions

Conception and design of the work were done by M.P. Acquisition, analysis and interpretation of data, drafting and reviewing it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable for all aspects of the work were done by D.R., L.D., and M.P.




Publication History

Received: 28 March 2025

Accepted: 28 May 2025

Article published online:
24 June 2025

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