Singer Lynn T, Salvator Ann, Arendt Robert, Minnes Sonia, Farkas Kathleen, Kliegman Robert
Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
Neurotoxicol Teratol. 2002 Mar-Apr;24(2):127-35. doi: 10.1016/s0892-0362(01)00208-2.
To assess teratogenic effects of cocaine exposure and maternal psychological distress on birth outcomes, we conducted a longitudinal prospective study of 415 infants (218 cocaine-exposed--CE, 197 nonexposed--NE). Drug exposure was determined through a combination of maternal self-report, urine, and meconium screens. Maternal psychological distress postpartum was evaluated through a standardized, normative, self-report assessment. An extensive set of confounding variables was controlled, including severity of exposure to alcohol, tobacco, marijuana and other drugs, maternal age, race, parity, number of prenatal care visits, educational, marital, and socioeconomic status, and verbal and nonverbal intelligence. CE infants were smaller on all birth parameters and more likely to be preterm, small for gestational age, and microcephalic than NE infants. Forty-one percent of cocaine users had clinically significant psychological symptoms, compared to 20% of a high-risk comparison group of noncocaine users. Consistent with a teratologic model, cocaine exposure independently predicted offspring birthweight, length, and head circumference. Maternal psychological distress self-reported postnatally also independently predicted head circumference. Tobacco, alcohol, and marijuana exposures were also significant independent predictors of some fetal growth parameters. In addition, maternal distress symptoms, which may be reflective of maternal mental health disorders or responses to stress, added significantly to the risk for poorer fetal growth.
为评估可卡因暴露及母亲心理困扰对出生结局的致畸作用，我们对415名婴儿（218名暴露于可卡因——CE，197名未暴露——NE）进行了一项纵向前瞻性研究。通过母亲自我报告、尿液及胎粪筛查相结合的方式确定药物暴露情况。产后母亲心理困扰通过标准化、规范性的自我报告评估进行评价。控制了一系列广泛的混杂变量，包括酒精、烟草、大麻及其他药物的暴露程度、母亲年龄、种族、产次、产前检查次数、教育程度、婚姻状况及社会经济地位，以及言语和非言语智力。与NE婴儿相比，CE婴儿在所有出生参数上都更小，更有可能早产、小于胎龄及小头畸形。41%的可卡因使用者有临床显著的心理症状，相比之下，非可卡因使用者的高危对照组这一比例为20%。与致畸模型一致，可卡因暴露独立预测后代出生体重、身长及头围。产后自我报告的母亲心理困扰也独立预测头围。烟草、酒精及大麻暴露也是一些胎儿生长参数的显著独立预测因素。此外，母亲的困扰症状可能反映母亲心理健康障碍或对应激的反应，显著增加了胎儿生长较差的风险。
