Binata Shrestha, Sujan Koju, Ekata Shrestha
Peripartum periods are highly susceptible to both xenobiotic toxin exposure and endocrine abnormalities. Traditional testing uses independent immunoassays for toxicological and endocrine assessment, which often leads to delay, cross-reactivity, and undetected coexisting pathologies. The use of liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) allows for parallel and highly specific measurements of toxicological and endocrine markers through a single assay. This literature review will explore the epidemiology of toxicant exposure and endocrine dysfunction during pregnancy, compare LC-MS/MS and traditional immunoassays, assess evidence for dual-domain screening, and examine implementation issues. The LC-MS/MS had better analytical capabilities with sensitivity of 90-99% and specificity of 95-99.5% as opposed to the immunoassays with sensitivity of 68-92% and specificity of 65-94%. Detection limits were also 10-1000 times lower for important analytes including synthetic opioids, endocrine disruptors, and trace steroids. The integrated screening allowed detection of both toxicological and endocrine disorders in 15-22% of high risk pregnancies. Early detection of abnormal conditions using the LC-MS/MS test was linked with decreases in NICU admissions, preterm births, neonatal withdrawal syndromes, and thyroid status misclassifications. Cost-effectiveness analysis showed favorable results at moderate to high volumes. The LC-MS/MS screening is more clinically and analytically effective than the traditional siloed testing.