{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:39:49Z","timestamp":1792445989987,"version":"4.5.0"},"reference-count":70,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Perinatol"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1038\/s41372-026-02727-5","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:37:23Z","timestamp":1779781043000},"page":"1845-1854","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adverse maternal and neonatal effects associated with perinatal xylazine exposure: a systematic review"],"prefix":"10.1038","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7705-5542","authenticated-orcid":false,"given":"Pooja R.","family":"Sarkar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9420-8884","authenticated-orcid":false,"given":"Austin","family":"Pothikamjorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dallas","family":"Hamlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3399-9637","authenticated-orcid":false,"given":"Thomas","family":"Cummiskey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"McNichol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin P.","family":"Hill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"2727_CR1","doi-asserted-by":"publisher","first-page":"e2453303","DOI":"10.1001\/jamanetworkopen.2024.53303","volume":"8","author":"SG Auty","year":"2025","unstructured":"Auty SG, Frakt AB, Shafer PR, Stein MD, Gordon SH. Severe maternal morbidity among pregnant people with opioid use disorder enrolled in Medicaid. JAMA Netw Open. 2025;8:e2453303 https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.53303.","journal-title":"JAMA Netw Open"},{"key":"2727_CR2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.ogc.2022.10.015","volume":"50","author":"AR Sanjanwala","year":"2023","unstructured":"Sanjanwala AR, Lim G, Krans EE. Opioids and opioid use disorder in pregnancy. Obstet Gynecol Clin North Am. 2023;50:229\u201340. https:\/\/doi.org\/10.1016\/j.ogc.2022.10.015.","journal-title":"Obstet Gynecol Clin North Am"},{"key":"2727_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/906723","volume":"2014","author":"VE Whiteman","year":"2014","unstructured":"Whiteman VE, Salemi JL, Mogos MF, Cain MA, Aliyu MH, Salihu HM. Maternal opioid drug use during pregnancy and its impact on perinatal morbidity, mortality, and the costs of medical care in the United States. J Pregnancy. 2014;2014:1\u20138. https:\/\/doi.org\/10.1155\/2014\/906723.","journal-title":"J Pregnancy"},{"key":"2727_CR4","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1002\/ijgo.70299","volume":"171","author":"WR White","year":"2025","unstructured":"White WR, Coker JL, Brown CC. Impact of substance use and trauma on postpartum readmission rates and hospitalization costs: an observational study. Int J Gynecol Obstet. 2025;171:1272\u20137. https:\/\/doi.org\/10.1002\/ijgo.70299.","journal-title":"Int J Gynecol Obstet"},{"key":"2727_CR5","doi-asserted-by":"publisher","first-page":"e2013456","DOI":"10.1001\/jamanetworkopen.2020.13456","volume":"3","author":"SW Patrick","year":"2020","unstructured":"Patrick SW, Richards MR, Dupont WD, McNeer E, Buntin MB, Martin PR, et al. Association of pregnancy and insurance status with treatment access for opioid use disorder. JAMA Netw Open. 2020;3:e2013456 https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.13456.","journal-title":"JAMA Netw Open"},{"key":"2727_CR6","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1001\/jamapsychiatry.2023.4523","volume":"81","author":"B Han","year":"2024","unstructured":"Han B, Compton WM, Einstein EB, Elder E, Volkow ND. Pregnancy and postpartum drug overdose deaths in the US before and during the COVID-19 pandemic. JAMA Psychiatry. 2024;81:270 https:\/\/doi.org\/10.1001\/jamapsychiatry.2023.4523.","journal-title":"JAMA Psychiatry"},{"key":"2727_CR7","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1097\/AOG.0000000000002734","volume":"132","author":"DM Schiff","year":"2018","unstructured":"Schiff DM, Nielsen T, Terplan M, Hood M, Bernson D, Diop H, et al. Fatal and nonfatal overdose among pregnant and postpartum women in massachusetts. Obstet Gynecol. 2018;132:466\u201374. https:\/\/doi.org\/10.1097\/AOG.0000000000002734.","journal-title":"Obstet Gynecol"},{"key":"2727_CR8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1176\/appi.ajp-rj.2025.200303","volume":"20","author":"M Rimawi","year":"2025","unstructured":"Rimawi M, Hamlin D. Xylazine: a review of intoxication, overdose, and withdrawal symptoms. Am J Psychiatry Resid J. 2025;20:11\u20133. https:\/\/doi.org\/10.1176\/appi.ajp-rj.2025.200303.","journal-title":"Am J Psychiatry Resid J"},{"key":"2727_CR9","doi-asserted-by":"publisher","first-page":"204","DOI":"10.31389\/jied.122","volume":"4","author":"F Montero","year":"2022","unstructured":"Montero F, Bourgois P, Friedman J. Potency-enhancing synthetics in the drug overdose epidemic: xylazine (\u201ctranq\u201d), fentanyl, methamphetamine, and the displacement of heroin in Philadelphia and Tijuana. J Illicit Econ Dev. 2022;4:204\u201322. https:\/\/doi.org\/10.31389\/jied.122.","journal-title":"J Illicit Econ Dev"},{"key":"2727_CR10","doi-asserted-by":"publisher","first-page":"1949","DOI":"10.1016\/S0140-6736(23)01686-0","volume":"402","author":"DT Zhu","year":"2023","unstructured":"Zhu DT, Friedman J, Bourgois P, Montero F, Tamang S. The emerging fentanyl\u2013xylazine syndemic in the USA: challenges and future directions. Lancet. 2023;402:1949\u201352. https:\/\/doi.org\/10.1016\/S0140-6736(23)01686-0.","journal-title":"Lancet"},{"key":"2727_CR11","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2024.112450","volume":"264","author":"HN Carlson","year":"2024","unstructured":"Carlson HN, Spera AG, Smith MA. Effects of xylazine on naloxone-precipitated fentanyl withdrawal in male and female rats. Drug Alcohol Depend. 2024;264:112450. https:\/\/doi.org\/10.1016\/j.drugalcdep.2024.112450.","journal-title":"Drug Alcohol Depend"},{"key":"2727_CR12","doi-asserted-by":"publisher","first-page":"e240572","DOI":"10.1001\/jamanetworkopen.2024.0572","volume":"7","author":"M Hochheimer","year":"2024","unstructured":"Hochheimer M, Strickland JC, Rabinowitz JA, Ellis JD, Dunn KE, Huhn AS. Knowledge, preference, and adverse effects of xylazine among adults in substance use treatment. JAMA Netw Open. 2024;7:e240572 https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.0572.","journal-title":"JAMA Netw Open"},{"key":"2727_CR13","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1111\/j.1365-2885.1988.tb00189.x","volume":"11","author":"SA Greene","year":"1988","unstructured":"Greene SA, Thurmon JC. Xylazine \u2013 a review of its pharmacology and use in veterinary medicine. J Vet Pharmacol Ther. 1988;11:295\u2013313. https:\/\/doi.org\/10.1111\/j.1365-2885.1988.tb00189.x.","journal-title":"J Vet Pharmacol Ther"},{"key":"2727_CR14","doi-asserted-by":"publisher","unstructured":"Knight A. Xylazine. J Am Vet Med Assoc. 1980;176:454\u20135. https:\/\/doi.org\/10.2460\/javma.1980.176.05.454.","DOI":"10.2460\/javma.1980.176.05.454"},{"key":"2727_CR15","doi-asserted-by":"publisher","first-page":"546","DOI":"10.17221\/92\/2018-VETMED","volume":"63","author":"O Guzel","year":"2018","unstructured":"Guzel O, Kaya DA, Altunatmaz K, Sevim G, Sezer D, Erdikmen DO. Evaluation of the cardiorespiratory effects of the alpha-2 adrenoceptor agonists xylazine, medetomidine and dexmedetomidine in combination with ketamine in dogs. Veterin\u00e1rn\u00ed Med. 2018;63:546\u201354. https:\/\/doi.org\/10.17221\/92\/2018-VETMED.","journal-title":"Veterin\u00e1rn\u00ed Med"},{"key":"2727_CR16","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/0002-9378(84)90712-9","volume":"148","author":"CAM Jansen","year":"1984","unstructured":"Jansen CAM, Lowe KC, Nathanielsz PW. The effects of xylazine on uterine activity, fetal and maternal oxygenation, cardiovascular function, and fetal breathing. Am J Obstet Gynecol. 1984;148:386\u201390. https:\/\/doi.org\/10.1016\/0002-9378(84)90712-9.","journal-title":"Am J Obstet Gynecol"},{"key":"2727_CR17","unstructured":"De Lille AJ, Silvers ML, Cadario ME, Tran TQ, Cage CL, LeBlanc MM. Interactions of xylazine and acepromazine with oxytocin and the effects of these interactions on intrauterine pressure in normal mares and mares with delayed uterine clearance. J Reprod Fertil Suppl. 2000;56:373\u20139."},{"key":"2727_CR18","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1177\/0023677213480769","volume":"47","author":"LG Thaete","year":"2013","unstructured":"Thaete LG, Levin SI, Dudley AT. Impact of anaesthetics and analgesics on fetal growth in the mouse. Lab Anim. 2013;47:175\u201383. https:\/\/doi.org\/10.1177\/0023677213480769.","journal-title":"Lab Anim"},{"key":"2727_CR19","doi-asserted-by":"publisher","unstructured":"ZohaniGhayeni M, KazemiDarabadi S, Hajibemani A, Akbari G. Evaluation of possible effects of hyoscine in xylazine-induced fetal death in pregnant rats. Iran J Vet Surg. 2023; https:\/\/doi.org\/10.30500\/ivsa.2023.379508.1330.","DOI":"10.30500\/ivsa.2023.379508.1330"},{"key":"2727_CR20","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.2460\/ajvr.2002.63.1695","volume":"63","author":"DS Hodgson","year":"2002","unstructured":"Hodgson DS, Dunlop CI, Chapman PL, Smith JA. Cardiopulmonary effects of xylazine and acepromazine in pregnant cows in late gestation. Am J Vet Res. 2002;63:1695\u20139. https:\/\/doi.org\/10.2460\/ajvr.2002.63.1695.","journal-title":"Am J Vet Res"},{"key":"2727_CR21","doi-asserted-by":"publisher","first-page":"37","DOI":"10.33762\/bvetr.2007.55771","volume":"6","author":"M Eesa","year":"2007","unstructured":"Eesa M. The clinical evaluation of the effect of xylazine in pregnant buffaloes and cattle. Basrah J Vet Res. 2007;6:37\u201341.","journal-title":"Basrah J Vet Res"},{"key":"2727_CR22","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1016\/j.theriogenology.2017.12.033","volume":"108","author":"RL Sciorsci","year":"2018","unstructured":"Sciorsci RL, Piccinno M, Rizzo A. Scopolamine butylbromide decreases the xylazine-mediated contractility in bovine pregnant uteri. Theriogenology. 2018;108:348\u201353. https:\/\/doi.org\/10.1016\/j.theriogenology.2017.12.033.","journal-title":"Theriogenology"},{"key":"2727_CR23","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1016\/j.theriogenology.2014.01.031","volume":"81","author":"D Waldvogel","year":"2014","unstructured":"Waldvogel D, Bleul U. Effect of xylazine, isoxsuprine, and lidocaine on doppler sonographic uterine and umbilical blood flow measurements in cows during the last month of pregnancy. Theriogenology. 2014;81:993\u20131003. https:\/\/doi.org\/10.1016\/j.theriogenology.2014.01.031.","journal-title":"Theriogenology"},{"key":"2727_CR24","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/j.1365-2885.1994.tb00523.x","volume":"17","author":"R Perez","year":"1994","unstructured":"Perez R, Cox TF, Arrue R. Probable post-synaptic \u03b1- adrenergic mediated effect of xylazine on goat uterine motility. J Vet Pharmacol Ther. 1994;17:59\u201363. https:\/\/doi.org\/10.1111\/j.1365-2885.1994.tb00523.x.","journal-title":"J Vet Pharmacol Ther"},{"key":"2727_CR25","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1292\/jvms.58.211","volume":"58","author":"H Sakamoto","year":"1996","unstructured":"Sakamoto H, Misumi K, Nakama M, Aoki Y. The effects of xylazine on intrauterine pressure, uterine blood flow, maternal and fetal cardiovascular and pulmonary function in pregnant goats. J Vet Med Sci. 1996;58:211\u20137. https:\/\/doi.org\/10.1292\/jvms.58.211.","journal-title":"J Vet Med Sci"},{"key":"2727_CR26","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/S0034-5288(97)90161-2","volume":"63","author":"R P\u00e9rez","year":"1997","unstructured":"P\u00e9rez R, Garcia M, Arias P, Gallardo M, Valenzuela S, Rudolph MI. Inhibition of xylazine induced uterine contractility by clenbuterol and nifedipine. Res Vet Sci. 1997;63:73\u20136. https:\/\/doi.org\/10.1016\/S0034-5288(97)90161-2.","journal-title":"Res Vet Sci"},{"key":"2727_CR27","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1007\/s11259-024-10330-2","volume":"48","author":"H Samir","year":"2024","unstructured":"Samir H, Swelum AA, Farag A, El-Sherbiny HR. Emotional temperaments in advanced pregnant goats and its relationship with the feto-maternal blood flow and placentome echotexture. Vet Res Commun. 2024;48:1545\u201361. https:\/\/doi.org\/10.1007\/s11259-024-10330-2.","journal-title":"Vet Res Commun"},{"key":"2727_CR28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpet.2025.103711","volume":"392","author":"G Puzovic","year":"2025","unstructured":"Puzovic G, Wolan MJ, Shi Y, Collins GT. Interactions between cardiorespiratory effects of fentanyl and xylazine and their reversal in male and female Sprague-Dawley rats. J Pharmacol Exp Ther. 2025;392:103711. https:\/\/doi.org\/10.1016\/j.jpet.2025.103711.","journal-title":"J Pharmacol Exp Ther"},{"key":"2727_CR29","doi-asserted-by":"publisher","first-page":"e140","DOI":"10.1097\/AOG.0000000000002633","volume":"131","author":". ACOG Committee Opinion No. 736","year":"2018","unstructured":". ACOG Committee Opinion No. 736. Optimizing postpartum care. Obstet Gynecol. 2018;131:e140\u201350. https:\/\/doi.org\/10.1097\/AOG.0000000000002633.","journal-title":"Obstet Gynecol"},{"key":"2727_CR30","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109380","volume":"233","author":"J Friedman","year":"2022","unstructured":"Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, et al. Xylazine spreads across the US: a growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022;233:109380. https:\/\/doi.org\/10.1016\/j.drugalcdep.2022.109380.","journal-title":"Drug Alcohol Depend"},{"key":"2727_CR31","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-023-00867-x","volume":"20","author":"DT Zhu","year":"2023","unstructured":"Zhu DT. Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review. Harm Reduct J. 2023;20:131. https:\/\/doi.org\/10.1186\/s12954-023-00867-x.","journal-title":"Harm Reduct J"},{"key":"2727_CR32","doi-asserted-by":"crossref","unstructured":"Oyadeyi C, Mughees W, Nakiboglu D, Baxter JK, Khandelwal M. Xylazine use in pregnancy: a literature review of opioid adulterant, xylazine, in pregnancy. Obstet Gynecol. 2025;145:68S.","DOI":"10.1097\/AOG.0000000000005918.036"},{"key":"2727_CR33","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1080\/10550887.2024.2391156","volume":"43","author":"I Hull","year":"2025","unstructured":"Hull I, Jawa R, Shang M, Davis C, King C, McMurtrie G, et al. Implications of xylazine exposure in pregnancy: a narrative review. J Addict Dis. 2025;43:394\u2013401. https:\/\/doi.org\/10.1080\/10550887.2024.2391156.","journal-title":"J Addict Dis"},{"key":"2727_CR34","doi-asserted-by":"publisher","first-page":"3410","DOI":"10.3390\/app15063410","volume":"15","author":"D Iacopetta","year":"2025","unstructured":"Iacopetta D, Catalano A, Aiello F, Andreu I, Sinicropi MS, Lentini G. Xylazine, a drug adulterant whose use is spreading in the human population from the U.S. to the U.K. and all europe: an updated review. Appl Sci. 2025;15:3410 https:\/\/doi.org\/10.3390\/app15063410.","journal-title":"Appl Sci"},{"key":"2727_CR35","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/j.psym.2016.05.001","volume":"57","author":"P Mulders","year":"2016","unstructured":"Mulders P, Van Duijnhoven V, Schellekens A. Xylazine dependence and detoxification: a case report. Psychosom JACLP. 2016;57:529\u201333. https:\/\/doi.org\/10.1016\/j.psym.2016.05.001.","journal-title":"Psychosom JACLP"},{"key":"2727_CR36","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1097\/ADM.0000000000000955","volume":"16","author":"R Ehrman-Dupre","year":"2022","unstructured":"Ehrman-Dupre R, Kaigh C, Salzman M, Haroz R, Peterson L-K, Schmidt R. Management of xylazine withdrawal in a hospitalized patient: a case report. J Addict Med. 2022;16:595\u20138. https:\/\/doi.org\/10.1097\/ADM.0000000000000955.","journal-title":"J Addict Med"},{"key":"2727_CR37","unstructured":"Veritas Health Innovation. Covidence systematic review software. www.covidence.org. 2014."},{"key":"2727_CR38","doi-asserted-by":"publisher","first-page":"2308","DOI":"10.1111\/1556-4029.15596","volume":"69","author":"BL Peterson","year":"2024","unstructured":"Peterson BL, Midthun KM. Prevalence of fentanyl in the pediatric postmortem population from 2019 to 2023. J Forensic Sci. 2024;69:2308\u201316. https:\/\/doi.org\/10.1111\/1556-4029.15596.","journal-title":"J Forensic Sci"},{"key":"2727_CR39","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1080\/15563650.2025.2490831","volume":"63","author":"A Cembellin-Kao","year":"2025","unstructured":"Cembellin-Kao A, Aldy K, Brent J, Culbreth R, LaBozzetta C, Turcios MA, et al. Occult bromazolam exposure in patients presenting with opioid or stimulant overdose. Clin Toxicol. 2025;63:330\u20136. https:\/\/doi.org\/10.1080\/15563650.2025.2490831.","journal-title":"Clin Toxicol"},{"key":"2727_CR40","doi-asserted-by":"publisher","unstructured":"Cissna CE, Grzych HM, Kalinowski MK, Josephsen JB. Neonate with intrauterine xylazine exposure: a case report. J Addict Med. 2025; https:\/\/doi.org\/10.1097\/ADM.0000000000001539.","DOI":"10.1097\/ADM.0000000000001539"},{"key":"2727_CR41","unstructured":"Nixon S, Ansah-Zame A, Farah R, Bazydlo L, Holstege C. Prenatal bromazolam exposure: documented detection in neonates. In: North American Congress of Clinical Toxicology; 2025; Chicago. Clinical Toxicology; 2025. p 178."},{"key":"2727_CR42","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.13187","volume":"5","author":"O Nwodim","year":"2024","unstructured":"Nwodim O, Karsalia R, Heslin ME, Lieberman AE, Wang SZ, Kalanuria AA, et al. Opioid-related xylazine toxicity manifesting as myonecrosis, rhabdomyolysis, multifocal ischemic cerebral infarcts, and cerebral edema. JACEP Open. 2024;5:e13187. https:\/\/doi.org\/10.1002\/emp2.13187.","journal-title":"JACEP Open"},{"key":"2727_CR43","unstructured":"Kelsey SG, Litzky J, Pahl A, Young L, Comeau M-K, Buonanno O. In utero xylazine exposure associated with feeding difficulties in infants with neonatal opioid exposure. Burlington, VT: University of Vermont; Report No. 48."},{"key":"2727_CR44","doi-asserted-by":"publisher","first-page":"S86","DOI":"10.1016\/j.jogn.2024.05.134","volume":"53","author":"D Coy","year":"2024","unstructured":"Coy D, Racines A, Lea K, Patel N, Sukta A, Jones JT. Testing umbilical cord tissue for prenatal exposure to xylazine in an at-risk population. J Obstet Gynecol Neonatal Nurs. 2024;53:S86\u20137. https:\/\/doi.org\/10.1016\/j.jogn.2024.05.134.","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"key":"2727_CR45","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2023.1127020","volume":"11","author":"KM Midthun","year":"2023","unstructured":"Midthun KM, Nelson BN, Strathmann FG, Browne T, Logan BK. Analysis of umbilical cord tissue as an indicator of in utero exposure to toxic adulterating substances. Front Pediatr. 2023;11:1127020. https:\/\/doi.org\/10.3389\/fped.2023.1127020.","journal-title":"Front Pediatr"},{"key":"2727_CR46","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1093\/jat\/bkab094","volume":"46","author":"BN Nelson","year":"2022","unstructured":"Nelson BN, Strathmann FG, Browne T, Cervantes A, Logan BK. Qualitative LC\u2013Q-TOF analysis of umbilical cord tissue via data-dependent acquisition as an indicator of in utero exposure to toxic adulterating substances. J Anal Toxicol. 2022;46:619\u201324. https:\/\/doi.org\/10.1093\/jat\/bkab094.","journal-title":"J Anal Toxicol"},{"key":"2727_CR47","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1097\/ADM.0000000000001396","volume":"19","author":"C Trammel","year":"2025","unstructured":"Trammel C, Azimi V, Crews B, Roper S, Raghuraman N, Carter EB, et al. Xylazine positivity in opioid-positive drug screens on an inpatient labor unit. J Addict Med. 2025;19:233\u20135. https:\/\/doi.org\/10.1097\/ADM.0000000000001396.","journal-title":"J Addict Med"},{"key":"2727_CR48","unstructured":"Trammel C, Azimi V, Crews B, Roper S, Raghuraman N, Frolova AI, et al. Fentanyl exposure in the era of xylazine: an update on perinatal outcomes. In: Society for Maternal-Fetal Medicine (SMFM) Pregnancy Meeting. Denver, CO; 2025."},{"key":"2727_CR49","doi-asserted-by":"publisher","unstructured":"Moola S, Munn Z, Tufunaru C, Aromataris E, Sears K, Sfetc R, et al. Systematic reviews of aetiology and risk. In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis. JBI; 2024. https:\/\/doi.org\/10.46658\/JBIMES-24-06.","DOI":"10.46658\/JBIMES-24-06"},{"key":"2727_CR50","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.7326\/M23-2001","volume":"176","author":"J D\u2019Orazio","year":"2023","unstructured":"D\u2019Orazio J, Nelson L, Perrone J, Wightman R, Haroz R. Xylazine adulteration of the heroin\u2013fentanyl drug supply: a narrative review. Ann Intern Med. 2023;176:1370\u20136. https:\/\/doi.org\/10.7326\/M23-2001.","journal-title":"Ann Intern Med"},{"key":"2727_CR51","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1177\/29767342231214472","volume":"45","author":"JJ Carroll","year":"2024","unstructured":"Carroll JJ. Xylazine-associated wounds and related health concerns among people who use drugs: reports from front-line health workers in 7 US states. Subst Use Addict J. 2024;45:222\u201331. https:\/\/doi.org\/10.1177\/29767342231214472.","journal-title":"Subst Use Addict J"},{"key":"2727_CR52","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1177\/29767342251329681","volume":"46","author":"M Shang","year":"2025","unstructured":"Shang M, Hull I, Liebschutz JM, Abesamis M, Lynch M, Tamama K, et al. Building multidisciplinary consensus on inpatient xylazine management through clinical protocols. Subst Use Addict J. 2025;46:806\u201316. https:\/\/doi.org\/10.1177\/29767342251329681.","journal-title":"Subst Use Addict J"},{"key":"2727_CR53","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2025.102773","volume":"47","author":"S Turner","year":"2025","unstructured":"Turner S, Cook J, Graves L. Xylazine: an emerging threat in obstetrics. J Obstet Gynaecol Can. 2025;47:102773. https:\/\/doi.org\/10.1016\/j.jogc.2025.102773.","journal-title":"J Obstet Gynaecol Can"},{"key":"2727_CR54","doi-asserted-by":"publisher","first-page":"277","DOI":"10.17161\/kjm.vol16.20624","volume":"16","author":"G Noonan","year":"2023","unstructured":"Noonan G, Sethi R. Xylazine use in pregnancy: the effects of the fentanyl adulterant xylazine on pregnant patients and the developing fetus. Kans J Med. 2023;16:277\u20139. https:\/\/doi.org\/10.17161\/kjm.vol16.20624.","journal-title":"Kans J Med"},{"key":"2727_CR55","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s11916-024-01211-z","volume":"28","author":"AN Edinoff","year":"2024","unstructured":"Edinoff AN, Sall S, Upshaw WC, Spillers NJ, Vincik LY, De Witt AS, et al. Xylazine: a drug adulterant of clinical concern. Curr Pain Headache Rep. 2024;28:417\u201326. https:\/\/doi.org\/10.1007\/s11916-024-01211-z.","journal-title":"Curr Pain Headache Rep"},{"key":"2727_CR56","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2024.100241","volume":"11","author":"E Thompson","year":"2024","unstructured":"Thompson E, Tardif J, Ujeneza M, Badea A, Green TC, McKee H, et al. Pilot findings on the real-world performance of xylazine test strips for drug residue testing and the importance of secondary testing methods. Drug Alcohol Depend Rep. 2024;11:100241. https:\/\/doi.org\/10.1016\/j.dadr.2024.100241.","journal-title":"Drug Alcohol Depend Rep"},{"key":"2727_CR57","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1093\/jalm\/jfaf037","volume":"10","author":"L Scott","year":"2025","unstructured":"Scott L, Davis K, Park JN, Majeed S. Evaluating the sensitivity, selectivity, and cross-reactivity of lateral flow immunoassay xylazine test strips. J Appl Lab Med. 2025;10:887\u2013900. https:\/\/doi.org\/10.1093\/jalm\/jfaf037.","journal-title":"J Appl Lab Med"},{"key":"2727_CR58","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1037\/pha0000670","volume":"32","author":"SN Khatri","year":"2024","unstructured":"Khatri SN, Sadek S, Kendrick PT, Bondy EO, Hong M, Pauss S, et al. Xylazine suppresses fentanyl consumption during self-administration and induces a unique sex-specific withdrawal syndrome that is not altered by naloxone in rats. Exp Clin Psychopharmacol. 2024;32:150\u20137. https:\/\/doi.org\/10.1037\/pha0000670.","journal-title":"Exp Clin Psychopharmacol"},{"key":"2727_CR59","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1097\/ALN.0000000000004622","volume":"139","author":"M van Lemmen","year":"2023","unstructured":"van Lemmen M, Florian J, Li Z, Van Velzen M, Van Dorp E, Niesters M, et al. Opioid overdose: limitations in naloxone reversal of respiratory depression and prevention of cardiac arrest. Anesthesiology. 2023;139:342\u201353. https:\/\/doi.org\/10.1097\/ALN.0000000000004622.","journal-title":"Anesthesiology"},{"key":"2727_CR60","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1346109","volume":"12","author":"A Dahan","year":"2024","unstructured":"Dahan A, Franko TS, Carroll JW, Craig DS, Crow C, Galinkin JL, et al. Fact vs. fiction: naloxone in the treatment of opioid-induced respiratory depression in the current era of synthetic opioids. Front Public Health. 2024;12:1346109. https:\/\/doi.org\/10.3389\/fpubh.2024.1346109.","journal-title":"Front Public Health"},{"key":"2727_CR61","doi-asserted-by":"publisher","DOI":"10.1177\/20503121251348068","volume":"13","author":"KS Sandhu","year":"2025","unstructured":"Sandhu KS, Kumar S, Garg K, Aggarwal K, Tiwwary M, Perry G, et al. The xylazine-fentanyl nexus: a public health emergency. Sage Open Med. 2025;13:20503121251348068. https:\/\/doi.org\/10.1177\/20503121251348068.","journal-title":"Sage Open Med"},{"key":"2727_CR62","doi-asserted-by":"publisher","DOI":"10.1016\/j.addicn.2024.100155","volume":"11","author":"ML Bedard","year":"2024","unstructured":"Bedard ML, Huang X-P, Murray JG, Nowlan AC, Conley SY, Mott SE, et al. Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to opioid antagonism. Addict Neurosci. 2024;11:100155. https:\/\/doi.org\/10.1016\/j.addicn.2024.100155.","journal-title":"Addict Neurosci"},{"key":"2727_CR63","doi-asserted-by":"publisher","unstructured":"Watkins J, Hahn R, Dempsey M, Hohmann AG. Xylazine exacerbates fentanyl-induced respiratory depression and prevents rescue by naloxone in mice. 2025. https:\/\/doi.org\/10.1101\/2025.06.18.660459","DOI":"10.1101\/2025.06.18.660459"},{"key":"2727_CR64","doi-asserted-by":"publisher","DOI":"10.1002\/ardp.202500041","volume":"358","author":"G Floresta","year":"2025","unstructured":"Floresta G, Granzotto A, Patamia V, Arillotta D, Papanti GD, Guirguis A, et al. Xylazine as an emerging new psychoactive substance; focuses on both 5-HT7 and \u03ba-opioid receptors\u2019 molecular interactions and isosteric replacement. Arch Pharm. 2025;358:e2500041. https:\/\/doi.org\/10.1002\/ardp.202500041.","journal-title":"Arch Pharm"},{"key":"2727_CR65","doi-asserted-by":"publisher","first-page":"1904","DOI":"10.1001\/jama.2023.8625","volume":"329","author":"R Rubin","year":"2023","unstructured":"Rubin R. Here\u2019s what to know about xylazine, aka tranq, the animal tranquilizer increasingly found in illicit fentanyl samples. JAMA. 2023;329:1904 https:\/\/doi.org\/10.1001\/jama.2023.8625.","journal-title":"JAMA"},{"key":"2727_CR66","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1056\/NEJMp2303120","volume":"388","author":"R Gupta","year":"2023","unstructured":"Gupta R, Holtgrave DR, Ashburn MA. Xylazine \u2014 medical and public health imperatives. N Engl J Med. 2023;388:2209\u201312. https:\/\/doi.org\/10.1056\/NEJMp2303120.","journal-title":"N Engl J Med"},{"key":"2727_CR67","doi-asserted-by":"publisher","first-page":"119","DOI":"10.4103\/tjem.tjem_198_22","volume":"23","author":"LK Choon","year":"2023","unstructured":"Choon LK, Khiruddin AI, Annuar WMWM, Shamsuddin SR. A case series of accidental xylazine intoxication in humans; Is there a role of naloxone as an antidote?. Turk J Emerg Med. 2023;23:119\u201322. https:\/\/doi.org\/10.4103\/tjem.tjem_198_22.","journal-title":"Turk J Emerg Med"},{"key":"2727_CR68","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2025.118521","volume":"384","author":"DT Zhu","year":"2025","unstructured":"Zhu DT, Mitragotri S, Cano M. Temporal and spatial patterns of xylazine and medetomidine detected in the DEA\u2019s National Forensic Laboratory Information System (NFLIS) reports. Soc Sci Med. 2025;384:118521. https:\/\/doi.org\/10.1016\/j.socscimed.2025.118521.","journal-title":"Soc Sci Med"},{"key":"2727_CR69","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2025.112763","volume":"274","author":"K Hochstatter","year":"2025","unstructured":"Hochstatter K, Nadel T, Sisco E, Bourgois P, Laurel S, Appley MG, et al. Characterizing rapid changes in the prevalence and concentration of key compounds in Philadelphia\u2019s street opioid retail supply, March 2024-March 2025. Drug Alcohol Depend. 2025;274:112763. https:\/\/doi.org\/10.1016\/j.drugalcdep.2025.112763.","journal-title":"Drug Alcohol Depend"},{"key":"2727_CR70","doi-asserted-by":"publisher","first-page":"266","DOI":"10.15585\/mmwr.mm7415a2","volume":"74","author":"S Huo","year":"2025","unstructured":"Huo S, London K, Murphy L, Casey E, Durney P, Arora M, et al. Notes from the field: suspected medetomidine withdrawal syndrome among fentanyl-exposed patients \u2014 Philadelphia, Pennsylvania, September 2024\u2013January 2025. Morb Mortal Wkly Rep. 2025;74:266\u20138. https:\/\/doi.org\/10.15585\/mmwr.mm7415a2.","journal-title":"Morb Mortal Wkly Rep"}],"container-title":["Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41372-026-02727-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41372-026-02727-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41372-026-02727-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:01:43Z","timestamp":1792443703000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41372-026-02727-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":70,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["2727"],"URL":"https:\/\/doi.org\/10.1038\/s41372-026-02727-5","relation":{},"ISSN":["0743-8346","1476-5543"],"issn-type":[{"value":"0743-8346","type":"print"},{"value":"1476-5543","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"6 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This study was determined to be exempt from IRB review by our institutional Committee on Clinical Investigations (2026D000399).","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Ethics"}}]}}