In utero cannabis exposure and pregnancy denial: A case report on unexpected neonatal death

Aim

Cannabis use during pregnancy is known to be associated with fetal growth reduction [1] and to be a risk factor in the sudden death syndrome [2]. This case report is about a neonatal death possibly linked to cannabis use during pregnancy.

Method

A 27-year-old woman was awakened by severe abdominal pain and sweating. She went to the bathroom to have a bath and felt “something coming out” of her. She reports not having heard any cry or seen any movement of the baby but she may have heard a sound like an inhalation. The mother was then brought to hospital. Investigation revealed that the mother claimed to be on hormonal contraception but was unable to provide any proof. She had not changed her lifestyle (cigarettes, alcohol) and had not noticed any changes except a slight weight gain. She had done a pregnancy test, but she told it was negative. All that information supports the possibility of pregnancy denial with unexpected delivery. The forensic autopsy conducted on the baby's remains established that the fetus was viable to full-term or near-term. No traumatic injuries, apparent malformations or macroscopic signs of any pathology that could have caused death were observed. Toxicological samples were collected: pleural and pericardial fluid, cardiac and peripheral blood, gastric contents, meconium and hair. Toxicological analyses were performed on cardiac and peripheral blood, meconium, gastric contents and hair using current methods (GC-MS, LC-MS/MS, HS-GC-FID).

Results

Toxicological analyses found THC-COOH in peripheral and cardiac blood at 4.4 and 5.4 ng/mL, respectively. THC, 11-OH-THC, and THC-COOH were found in gastric contents at 1.8, 1.7, and 10.2 ng/mL, respectively. Meconium analysis found THC, THC-COOH, 11-OH-THC and CBD at 6.3, 78, 107 and 39 ng/mL respectively. Hair analysis indicated the presence of THC, CBN, and CBD at 117, 24, and 75 pg/mg, respectively.

Conclusion

The cannabinoids concentrations determined in the gastric contents and cardiac or peripheral blood are too low to indicate cannabis ingestion and appear more likely to be secondary to diffusion from the vascular compartment. Cannabinoids THC, CBN and CBD were also detected in the infant's hair. These results collectively indicate in utero exposure to cannabis [3]. In pregnant women, cannabis use can result into these cannabinoids crossing the placental barrier and reaching the fetus [4]. Starting from the eighth month of pregnancy, these molecules can become incorporated into fetal hair [5]. Studies have shown a positive correlation between cannabis use during pregnancy and sudden infant death syndrome [6], [7], [8]. In this case, the analysis of the mother's hair would have been useful to understand her consumption habits and establish the imputability between the maternal drug use and the fetal death [9].