The Direct and Indirect Effects of Methamphetamine on Fetuses and Infants.

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 Şanlıurfa (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.