{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:08:28Z","timestamp":1789380508786,"version":"build-2803163510"},"reference-count":40,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Prenatal methamphetamine exposure may adversely affect fetal and neonatal outcomes, but its contribution to fetal and infant death remains incompletely understood. This study aimed to describe six fetal or infant deaths in which methamphetamine and amphetamine were detected and maternal methamphetamine exposure was considered a possible contributing factor. Methods: After obtaining the necessary approvals, medico-legal records, autopsy findings, and toxicological results were retrospectively reviewed for six cases from Bursa (n = 3) and \u015eanl\u0131urfa (n = 3). Results: One case occurred in 2019, one in 2020, and four in 2021. Five cases involved preterm delivery between 24 and 32 gestational weeks, whereas Case 4 was born at 37 gestational weeks. Three cases were stillbirths, two infants died on postnatal day 4, and the term-born infant died on postnatal day 17. Methamphetamine and amphetamine were detected in postmortem specimens from all cases. Blood samples were available in five cases, with methamphetamine concentrations ranging from 19 to 256 ng\/mL and amphetamine concentrations ranging from 4 to 42 ng\/mL. In one case, only decomposition fluid was available. The organ damage attributable to methamphetamine and its role in the pathophysiology of death could not be fully established. Stimulant exposure was considered the most probable cause of death in Case 3, methamphetamine exposure was classified as the direct cause of death in Case 6, and methamphetamine exposure was considered a predisposing factor in the remaining four cases. Conclusions: Although methamphetamine and amphetamine were detected in all cases, these findings alone do not establish a causal relationship with death. Larger studies are needed to clarify prenatal and postnatal exposure pathways and to establish interpretive toxicological reference ranges for methamphetamine in fetal and infant populations.<\/jats:p>","DOI":"10.3390\/diagnostics16182962","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:34:01Z","timestamp":1789378441000},"page":"2962","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Direct and Indirect Effects of Methamphetamine on Fetuses and Infants"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4029-2613","authenticated-orcid":false,"given":"Ahmet Sedat","family":"D\u00fcndar","sequence":"first","affiliation":[{"name":"Bursa Forensic Medicine Group Directorate, Council of Forensic Medicine, Ministry of Justice, Bursa 16090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7185-2620","authenticated-orcid":false,"given":"\u0130smail","family":"Alt\u0131n","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, School of Medicine, Istanbul Medeniyet Un\u0131versity, Istanbul 34722, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8716-9452","authenticated-orcid":false,"given":"Yusuf","family":"Atan","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Faculty of Medicine, \u015eeyh Edebali University, Bilecik 11230, T\u00fcrkiye"},{"name":"Council of Forensic Medicine (Istanbul), Istanbul 34196, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"ref_1","first-page":"30","article-title":"The Prevention of Drug Abuse in Young Adults","volume":"11","author":"Albayrak","year":"2014","journal-title":"J. Educ. Res. Nurs."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Hedegaard, H., Mini\u00f1o, A.M., Spencer, M.R., and Warner, M. (2021). Drug Overdose Deaths in The United States, 1999\u20132020. NCHS Data Briefs, 1\u20138.","DOI":"10.15620\/cdc:112340"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"United Nations Office on Drugs and Crime (2024). World Drug Report 2024, United Nations. Available online: https:\/\/www.unodc.org\/unodc\/en\/data-and-analysis\/world-drug-report-2024.html.","DOI":"10.18356\/9789211065534"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/ADM.0000000000000101","article-title":"Methamphetamines and Pregnancy Outcomes","volume":"9","author":"Wright","year":"2015","journal-title":"J. Addict. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"148","DOI":"10.2105\/AJPH.2018.304771","article-title":"Amphetamine- and opioid-affected births: Incidence, outcomes, and costs, United States, 2004\u20132015","volume":"109","author":"Admon","year":"2019","journal-title":"Am. J. Public Health"},{"key":"ref_6","unstructured":"United Nations Office on Drugs and Crime (2022). World Drug Report 2022, United Nations."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/0890334415610080","article-title":"Transfer of Methamphetamine (MA) Into Breast Milk and Urine of Postpartum Women Who Smoked MA Tablets During Pregnancy: Implications for Initiation of Breastfeeding","volume":"32","author":"Chomchai","year":"2016","journal-title":"J. Hum. Lact."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1097\/AOG.0b013e3181e67094","article-title":"Methamphetamine Use During Pregnancy","volume":"116","author":"Good","year":"2010","journal-title":"Obstet. Gynaecol."},{"key":"ref_9","first-page":"40","article-title":"Methamphetamine Use in Pregnant Women in Hawaii: A Case Series","volume":"79","author":"Chin","year":"2020","journal-title":"Hawaii J. Health Soc. Welf."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1111\/1556-4029.14321","article-title":"Increasing methamphetamine detection in cases of early childhood fatalities","volume":"65","author":"Kenneally","year":"2020","journal-title":"J. Forensic Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101990","DOI":"10.1016\/j.jsps.2024.101990","article-title":"Challenges and insights: Methamphetamine analysis in post-mortem putrefied human tissues in a hot climate","volume":"32","author":"Alasmari","year":"2024","journal-title":"Saudi Pharm. J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Peruch, M., Buffon, M., Jakovski, Z., Spiliopoulou, C., Addobbati, R., Franzin, M., Magni, P.A., and D\u2019Errico, S. (2024). Comparative Toxicological Analyses of Traditional Matrices and Blow Fly Larvae in Four Cases of Highly Decomposed Human Cadavers. Insects, 15.","DOI":"10.3390\/insects15070500"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1007\/s11419-021-00601-x","article-title":"Unexpected results found in larvae samples from two postmortem forensic cases","volume":"40","author":"Groth","year":"2022","journal-title":"Forensic Toxicol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103021","DOI":"10.1016\/j.jflm.2025.103021","article-title":"Assessment of psoas muscle as an alternative matrix for postmortem toxicological screening: Qualitative agreement of xenobiotic detection with femoral and cardiac blood","volume":"116","author":"Vivares","year":"2025","journal-title":"J. Forensic Leg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111876","DOI":"10.1016\/j.forsciint.2023.111876","article-title":"Postmortem redistribution of amphetamines and benzodiazepines in humans: Important variables that might be influencing the central blood\/peripheral blood ratio","volume":"353","author":"Borra","year":"2023","journal-title":"Forensic Sci. Int."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Fenton, T.R., and Kim, J.H. (2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr., 13.","DOI":"10.1186\/1471-2431-13-59"},{"key":"ref_17","unstructured":"World Health Organization (2006). WHO Child Growth Standards: Length\/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development, World Health Organization."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Scientific Working Group for Forensic Toxicology (2013). Scientific Working Group for Forensic Toxicology (SWGTOX), Standard Practices for Method Validation in Forensic Toxicology. J. Anal. Toxicol., 37, 452\u2013474.","DOI":"10.1093\/jat\/bkt054"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wouldes, T.A., and Lester, B.M. (2023). Opioid, methamphetamine, and polysubstance use: Perinatal outcomes for the mother and infant. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1305508"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/add.15509","article-title":"Prenatal methamphetamine\u2014Impact on the mother and child\u2014A review","volume":"117","author":"Perez","year":"2022","journal-title":"Addiction"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1038\/s41372-021-01271-8","article-title":"Methamphetamine: Burden, mechanism and impact on pregnancy, the fetus, and newborn","volume":"42","author":"Sankaran","year":"2022","journal-title":"J. Perinatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"356.e1","DOI":"10.1016\/j.ajog.2024.05.033","article-title":"Prenatal methamphetamine use increases risk of adverse maternal and neonatal outcomes","volume":"231","author":"Hayer","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"8814168","DOI":"10.1155\/2021\/8814168","article-title":"Maternal and neonatal complications of methamphetamine use during pregnancy","volume":"2021","author":"Premchit","year":"2021","journal-title":"Obstet. Gynecol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Li, J.-H., Liu, J.-L., Zhang, K.-K., Chen, L.-J., Xu, J.-T., and Xie, X.-L. (2021). The adverse effects of prenatal METH exposure on the offspring: A review. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.715176"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1038\/jp.2012.59","article-title":"Amphetamines, the pregnant woman and her children: A review","volume":"32","author":"Oei","year":"2012","journal-title":"J. Perinatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/jat\/21.6.515","article-title":"Fetal and infant deaths associated with maternal methamphetamine abuse","volume":"21","author":"Stewart","year":"1997","journal-title":"J. Anal. Toxicol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"8","DOI":"10.20431\/2456-0049.0801002","article-title":"Maternal and fetal death due to fentanyl, methamphetamine and cocaine use\u2014A case report","volume":"8","author":"Siddique","year":"2024","journal-title":"ARC J. Forensic Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.legalmed.2015.06.004","article-title":"Infant death associated with maternal methamphetamine use during pregnancy and delivery: A case report","volume":"17","author":"Sakai","year":"2015","journal-title":"Leg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2742","DOI":"10.1016\/j.radcr.2025.02.032","article-title":"Pathologies in a preterm infant exposed to methamphetamine in utero: Case report and literature review","volume":"20","author":"Alomari","year":"2025","journal-title":"Radiol. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Yang, Y., Yi, B., and Zhang, T. (2025). The Impact of Substance Use Disorder and Drug Transfer into Breast Milk: Implications for Maternal and Infant Health. Pharmaceutics, 17.","DOI":"10.3390\/pharmaceutics17060719"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1089\/bfm.2017.0010","article-title":"Two Case Studies Illustrating a Shared Decision-Making Approach to Illicit Methamphetamine Use and Breastfeeding","volume":"12","author":"Blandthorn","year":"2017","journal-title":"Breastfeed. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1177\/0890334415585067","article-title":"Narcolepsy Treated with Racemic Amphetamine during Pregnancy and Breastfeeding","volume":"31","author":"Beck","year":"2015","journal-title":"J. Hum. Lact."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1007\/s12024-024-00778-8","article-title":"A retrospective review of methylamphetamine detected in child deaths reported to the Victorian Coroner, Australia","volume":"20","author":"Mantinieks","year":"2024","journal-title":"Forensic Sci. Med. Pathol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Doi, M., Nakama, N., Sumi, T., Usui, N., and Shimada, S. (2022). Prenatal methamphetamine exposure causes dysfunction in glucose metabolism and low birthweight. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.1023984"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1021\/acschemneuro.1c00213","article-title":"Effects of Prenatal Methamphetamine Exposure on the Developing Human Brain: A Systematic Review of Neuroimaging Studies","volume":"12","author":"Dolatshahi","year":"2021","journal-title":"ACS Chem. Neurosci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"381","DOI":"10.4062\/biomolther.2020.044","article-title":"Methamphetamine-Induced Neuronal Damage: Neurotoxicity and Neuroinflammation","volume":"28","author":"Kim","year":"2020","journal-title":"Biomol. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"951616","DOI":"10.1155\/2011\/951616","article-title":"Drug testing for newborn exposure to illicit substances in pregnancy: Pitfalls and pearls","volume":"2011","author":"Farst","year":"2011","journal-title":"Int. J. Pediatr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e540","DOI":"10.1542\/peds.2011-3212","article-title":"Neonatal drug withdrawal","volume":"129","author":"Hudak","year":"2012","journal-title":"Pediatrics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1001\/jama.1991.03460150072026","article-title":"Disposition and pharmacodynamics of methamphetamine in pregnant sheep","volume":"265","author":"Burchfield","year":"1991","journal-title":"JAMA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"112986","DOI":"10.1016\/j.forsciint.2026.112986","article-title":"Prenatal methamphetamine exposure and fetal death: A retrospective autopsy-based study","volume":"386","author":"Yaman","year":"2026","journal-title":"Forensic Sci. Int."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2962\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T09:51:47Z","timestamp":1789379507000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,13]]},"references-count":40,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16182962"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16182962","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,13]]}}}