Addis A, Moretti M E, Ahmed Syed F, Einarson T R, Koren G
Centro per la Valutazione della Efficacia della Assistenza Sanitaria, Modena, Italy.
Reprod Toxicol. 2001 Jul-Aug;15(4):341-69. doi: 10.1016/s0890-6238(01)00136-8.
A very large number of women in the reproductive age group consume cocaine, leading to grave concerns regarding the long term health of millions of children after in utero exposure. The results of controlled studies have been contradictory, leading to confusion, and, possible, misinformation and misperception of teratogenic risk.
To systematically review available data on pregnancy outcome when the mother consumed cocaine.
A meta-analysis of all epidemiologic studies based on a priori criteria was conducted. Comparisons of adverse events in subgroups of exposed vs. unexposed children were performed. Analyses were based on several exposure groups: mainly cocaine, cocaine plus polydrug, polydrug but no cocaine, and drug free.
Thirty three studies met our inclusion criteria. For all end points of interest (rates of major malformations, low birth weight, prematurity, placental abruption, premature rupture of membrane [PROM], and mean birth weight, length and head circumference), cocaine-exposed infants had higher risks than children of women not exposed to any drug. However, most of these adverse effects were nullified when cocaine exposed children were compared to children exposed to polydrug but no cocaine. Only the risk of placental abruption and premature rupture of membranes were statistically associated with cocaine use itself.
Many of the perinatal adverse effects commonly attributed to cocaine may be caused by the multiple confounders that can occur in a cocaine using mother. Only the risk for placental abruption and PROM could be statistically related to cocaine. For other adverse effects, additional studies will be needed to ensure adequate statistical power.
大量育龄妇女吸食可卡因，这引发了人们对数百万子宫内接触可卡因的儿童长期健康的严重担忧。对照研究的结果相互矛盾，导致困惑，甚至可能产生错误信息和对致畸风险的误解。
系统回顾母亲吸食可卡因时妊娠结局的现有数据。
基于预先设定的标准对所有流行病学研究进行荟萃分析。对暴露组与未暴露组儿童亚组中的不良事件进行比较。分析基于几个暴露组：主要是可卡因组、可卡因加多种药物组、多种药物但不含可卡因组以及未使用药物组。
33项研究符合我们的纳入标准。对于所有感兴趣的终点（重大畸形率、低出生体重、早产、胎盘早剥、胎膜早破[PROM]以及平均出生体重、身长和头围），接触可卡因的婴儿比未接触任何药物的妇女所生儿童的风险更高。然而，当将接触可卡因的儿童与接触多种药物但不含可卡因的儿童进行比较时，这些不良影响大多被消除。只有胎盘早剥和胎膜早破的风险与可卡因使用本身存在统计学关联。
许多通常归因于可卡因的围产期不良影响可能是由使用可卡因的母亲中可能出现的多种混杂因素引起的。只有胎盘早剥和胎膜早破的风险在统计学上可能与可卡因有关。对于其他不良影响，需要进一步研究以确保有足够的统计效力。
