Richardson G A, Hamel S C, Goldschmidt L, Day N L
Western Psychiatric Institute and Clinic, Child Development Unit, University of Pittsburgh School of Medicine, PA 15213, USA. gar+@pitt.edu
Pediatrics. 1999 Aug;104(2):e18. doi: 10.1542/peds.104.2.e18.
It has not been possible to draw firm conclusions about the effects of prenatal cocaine exposure because of methodologic problems involved in the conduct of this research. This study, designed to overcome some of these methodologic problems, is a prospective, longitudinal investigation of the effects of prenatal cocaine/crack exposure on neonatal growth in two samples, one with and one without prenatal care (PC).
Women in the PC sample (n = 295) were interviewed at the end of each trimester about their use of cocaine, crack, alcohol, tobacco, marijuana, and other drugs. Women in the no prenatal care (NPC) sample (n = 98) were interviewed at delivery about their drug use during each trimester of pregnancy. In both samples, information was also obtained about sociodemographic, lifestyle, psychologic, and social support characteristics. Both samples consisted of women who were predominantly low income, single, and high school educated. Of the women, 48% in the PC sample were black; 81% in the NPC sample were black. Infants were examined during the postpartum hospital stay by project nurses who were blind to maternal substance use status.
Women in both samples who used cocaine/crack during pregnancy were older, had lower family incomes, and used more alcohol than did women who did not use cocaine/crack during pregnancy. In addition, women in the NPC sample were more likely to be black, less educated, gained less weight during pregnancy, and used more alcohol than did women in the PC sample, regardless of cocaine use. In both samples, cocaine/crack use during early pregnancy predicted reduced gestational age, birth weight, length, and head circumference, after controlling for the significant covariates of cocaine use. In a comparison of the samples, the offspring of the NPC/cocaine group were significantly smaller than were the offspring of the PC/no cocaine group, whereas the offspring of the PC/cocaine and NPC/cocaine groups did not differ.
These results indicate that exposure to cocaine/crack during early pregnancy decreases the intrauterine growth of exposed offspring in women with and without PC. Each of the growth parameters was affected indicating symmetric growth retardation. The adequacy of PC was not a significant factor in determining the difference between cocaine-exposed and nonexposed infants. These samples are being followed throughout childhood to determine whether there are long-term effects of prenatal cocaine/crack exposure on growth.
由于该研究实施过程中存在方法学问题，因此无法就产前接触可卡因的影响得出确凿结论。本研究旨在克服其中一些方法学问题，对两个样本中产前接触可卡因/快克对新生儿生长的影响进行前瞻性纵向调查，其中一个样本有产前护理，另一个样本没有产前护理（PC）。
对接受产前护理样本（n = 295）的女性在每个孕期结束时进行访谈，询问她们使用可卡因、快克、酒精、烟草、大麻及其他药物的情况。对未接受产前护理（NPC）样本（n = 98）的女性在分娩时进行访谈，询问她们孕期每个阶段的药物使用情况。在两个样本中，还获取了社会人口统计学、生活方式、心理及社会支持特征方面的信息。两个样本中的女性主要是低收入、单身且受过高中教育。在接受产前护理样本中，48%的女性为黑人；在未接受产前护理样本中，81%的女性为黑人。项目护士在产妇住院产后期间对婴儿进行检查，这些护士对产妇的物质使用状况不知情。
两个样本中孕期使用可卡因/快克的女性比未使用的女性年龄更大、家庭收入更低且饮酒更多。此外，无论是否使用可卡因，未接受产前护理样本中的女性比接受产前护理样本中的女性更可能是黑人、受教育程度更低、孕期体重增加更少且饮酒更多。在两个样本中，在控制了可卡因使用的显著协变量后，孕早期使用可卡因/快克预示着孕周、出生体重、身长和头围减小。在样本比较中，未接受产前护理/使用可卡因组的后代明显小于接受产前护理/未使用可卡因组的后代，而接受产前护理/使用可卡因组和未接受产前护理/使用可卡因组的后代没有差异。
这些结果表明，孕早期接触可卡因/快克会降低有或没有产前护理的女性中接触药物后代的宫内生长。每个生长参数均受影响，表明生长发育迟缓呈对称性。产前护理的充分性并非决定接触可卡因和未接触可卡因婴儿差异的重要因素。这些样本将在整个儿童期进行跟踪，以确定产前接触可卡因/快克对生长发育是否有长期影响。
