Goldstein R B, McAvay G J, Nunes E V, Weissman M M
R.O.W. Sciences, Inc., 1700 Research Boulevard, Suite #400, Rockville, MD 20850, USA.
J Subst Abuse. 2000;11(4):355-68. doi: 10.1016/s0899-3289(00)00032-8.
Substance use by pregnant women is socially stigmatized and may be legally punishable. This societal condemnation raises concerns about underascertainment of prenatal substance exposure of offspring if mothers are asked specifically about their behavior during gestation, versus their life histories without reference to gestational dates. This study assessed agreement between life history-focused and pregnancy-focused assessments of prenatal exposure, and percentages of offspring classified as exposed to a range of substances by each measure, in a sample of school-aged children of methadone-maintained, opioid-dependent parents.
Prenatal exposure was assessed in 172 offspring of 109 mothers by: (a) questionnaires administered to mothers about substance use during pregnancy; and (b) best-estimate (BE) diagnoses of substance use disorders in mothers overlapping with pregnancy dates. BE diagnoses were based on interviews with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, conducted by trained mental health professionals with mothers about their life histories of psychiatric and substance use disorders, as well as mothers' medical records. Chance-corrected agreement between the measures was examined using kappa statistics. Percentages of offspring classified as exposed by each method were compared using McNemar chi 2 tests.
Except for cigarettes, agreement between the measures was poor. Except for alcohol, diagnosed episodes of substance use disorders in mothers with dates overlapping pregnancy classified more offspring as exposed than mothers' responses to the questionnaire focusing on behavior while pregnant, though the differences in proportions identified as exposed were not always large or statistically significant.
When retrospective ascertainment of prenatal exposure is necessary, asking mothers for their own life histories, without reference to pregnancy dates, may be the preferred approach.
孕妇使用药物在社会上受到污名化，且可能会受到法律惩罚。这种社会谴责引发了人们的担忧，如果专门询问母亲孕期的行为，而非不提及孕期的生活史，那么后代产前药物暴露情况可能会漏报。本研究评估了以生活史为重点和以怀孕为重点的产前暴露评估之间的一致性，以及在一组由接受美沙酮维持治疗、依赖阿片类药物的父母所生的学龄儿童样本中，每种测量方法将后代归类为接触一系列药物的比例。
通过以下方式对109名母亲的172名后代的产前暴露情况进行评估：（a）向母亲发放关于孕期药物使用情况的问卷；（b）对与怀孕日期重叠的母亲药物使用障碍进行最佳估计（BE）诊断。BE诊断基于由训练有素的心理健康专业人员对母亲进行的情感障碍和精神分裂症时间表-终身版访谈，内容涉及她们的精神疾病和药物使用障碍生活史以及母亲的病历。使用kappa统计量检验测量方法之间的机遇校正一致性。使用McNemar卡方检验比较每种方法归类为暴露的后代比例。
除香烟外，测量方法之间的一致性较差。除酒精外，怀孕日期重叠的母亲药物使用障碍诊断病例将更多后代归类为暴露，这一比例高于母亲对关注孕期行为问卷的回答，尽管确定为暴露的比例差异并不总是很大或具有统计学意义。
当有必要对产前暴露进行回顾性确定时，询问母亲自己的生活史而不提及怀孕日期可能是首选方法。
