Why would some babies exposed to fentanyl or other drugs during gestation develop defects while others don't?.Is the problem some kind of interaction between the drug and genetics of either the mother or the baby?.Does it depend on how much fentanyl gets to the fetus?.Is the underlying cause fentanyl or some kind of contamination of the drug?. Mirnics plans to study the blood of the babies identified at Nemours and elsewhere to answer looming questions: "If there is no cholesterol, there is no life." That is because cholesterol is "essential for everything in your body, for every cell membrane, for every function," Mirnics said. Karoly Mirnics, the director of UNMC's Munroe-Meyer Institute, has dedicated research to studying the impact of a variety of drugs on cholesterol metabolism. The fentanyl-cholesterol theory may be proven - or not - through ongoing work at the University of Nebraska Medical Center in Omaha.ĭr. "It's a prospective study to evaluate consequences of drug exposures during pregnancy," Volkow said. Last year, NIDA launched a large research project called the Healthy Brain and Child Development Study aimed at following women and their children from pregnancy through age 10. "Having said that, reports like this one are very important, because they shed light on issues that we need to systematically investigate," Volkow said. "It's very hard to determine is this just the effect of fentanyl or is this really the effects of other drugs or other combination?" Nora Volkow, the director of the National Institute on Drug Abuse. The women in the study were "also taking many drugs," said Dr. Even mosquito-borne diseases, such as Zika, have been known to lead to microcephaly (unusually small heads) if babies are exposed in utero, though there is no evidence Zika plays a role in the cases. It could be that other street drugs or contaminants in the fentanyl supply are causing the defects. No proof yet links fentanyl to the cases, and in fact there are many possible causes. Still, Wadman said much more work is needed to confirm the findings, "even to prove that it is, indeed, the fentanyl and not anything that's laced in it or other drug that we're missing." Possible causes The babies tested positive for fentanyl exposure when they were born, but the Nemours team suspect they had been exposed to significant amounts of the drug throughout the entire pregnancies. "Although fentanyl's effect on cholesterol metabolism has not been directly tested, based on indirect evidence, it is biologically plausible that it affects cholesterol metabolism in the developing fetus," the authors wrote in the new report. In those cases, genetic variants affect how fetuses process cholesterol, which is necessary for normal cell function and brain development. Karen Gripp, a geneticist, of a syndrome called Smith-Lemli-Opitz. The physical similarities reminded Wadman and a Nemours colleague, Dr. Some have trouble feeding, and their thumbs may not be fully formed. Baby boys may have genital irregularities. Their feet may point down and inward, and two of their middle toes are webbed. Their noses tend to turn upward, and their lower jaws are often undersized. In addition to cleft palate, the 10 infants have unusually small bodies and heads. "That's when we were like we think we might have stumbled on something really big here." Six babies from the Nemours analysis in a photo published in an article in Genetics in Medicine Open, by Erin Wadman, et al., "A novel syndrome associated with prenatal fentanyl exposure." Elsevier 2023 And I was just thinking about how this patient reminded me so much of a patient I'd seen earlier in the year and then other patients I'd seen," Wadman said. "I was sitting there in the appointment, and I was just like this face looks so familiar. The aha moment linking the infants came in August 2022, when Wadman was called upon to consult in the case of a baby who'd been born with birth defects. Erin Wadman, a genetic counselor at Nemours, and her colleagues published their findings recently in Genetics in Medicine Open. Six babies were identified at Nemours Children's Health in Wilmington, Delaware, two in California and one each in Massachusetts and Rhode Island. "As we see these shared characteristics identified, we may be unroofing a real syndrome." Cherot hasn't personally cared for any of the babies. Elizabeth Cherot, the president of the March of Dimes.
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