As part of a multicenter longitudinal study on prenatal cocaine and/or opiate (COC-OP) exposure and child outcome, 4 clinical centers (Brown Univ., Univ. of Miami, Univ. of Tennessee, Memphis, Wayne State Univ.) screened 19,079 mothers between 5/93 and 5/95. 11,810 were eligible and consented. The cohort was 50% Black and 24% <2500 gms. Meconium was collected and centrally assayed for 72% of the cohort. Exposure status for COC-OP was based on maternal report or GC/MS confirmation. After initial EIA (EMIT) screening, positive samples were confirmed with GC/MS. Four metabolites of COC (cocaine(A), benzoylecgonine (B), cocaethylene (C), m-hydroxybenzoylecgonine (D, added midway through study)) and 5 of OP (morphine (A), codeine (B), 6-monoacetylmorphine (C), hydromorphone (D), hydrocodone (E)) were assayed as were THC, amphetamines and PCP. 70% of EIA screens for COC-OP were confirmed by GC/MS. Compared to maternal self-report GC/MS confirmation for COC showed 66.2% sensitivity and 97.6% specificity. Positive screens and GC/MS confirmation respectively were 7.2% and 36.9% for THC, 1.5% and 0% for amphetamines and.6% and 6% for PCP. For mothers who denied use of COC-OP 1.3-5.1% (clinic range) were GC/MS positive. Mothers who denied use but were GC/MS positive accounted for 21% of the exposed sample. Screening without GC/MS may overestimate exposure status. GC/MS is important in identifying subjects whose mothers denied use but showed positive meconium.Table

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