Huestis Marilyn A, Choo Robin E
Intramural Research Program, Chemistry and Drug Metabolism Section, National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA.
Forensic Sci Int. 2002 Aug 14;128(1-2):20-30. doi: 10.1016/s0379-0738(02)00160-3.
The social and economic impact of drug use on our global population continues to increase leaving no geographical, social or cultural group untouched. The National Institute on Drug Abuse (NIDA), in one of the few large surveys of maternal abuse, found that 5.5% of mothers reported taking an illicit substance during gestation. These figures certainly are underestimates due to the stigma of drug use during pregnancy and the accompanying legal, ethical and economic issues. Although drugs of choice and routes of administration vary by country, exposure of our most valuable resource, our children, to the developmental effects of drugs is an enormous problem. In utero drug exposure can have a severe impact not only on the development of the fetus, but also on the child during later stages of life. More than 75% of infants exposed to drugs have major medical problems as compared to 27% of unexposed infants. The cost of treating drug-affected infants was twice the cost of non-affected infants. Obstetrical complications including placental insufficiency, miscarriage, intrauterine death, and increased incidence of infectious and sexually-transmitted diseases are higher in the drug-abusing mother. Treatment for pregnant addicts should be a high priority for our governments. Increased awareness and improvement in our understanding of drug abuse in the medical, legal and social realms will enable us to reduce the barriers to treatment for this important population.Accurate identification of in utero drug exposure has important implications for the care of the mother and child, but can raise difficult legal issues. Society discourages prenatal care with the infliction of harsh criminal penalties. Maternal drug use during pregnancy can be monitored with urine, sweat, oral fluid and/or hair testing. Detection of in utero drug exposure has traditionally been accomplished through urine testing; however, the window of detection is short, reflecting drug use for only a few days before delivery. Monitoring exposure through testing of alternative matrices, such as neonatal meconium and hair, offers advantages including non-invasive collection and detection earlier in gestation. There are many unresolved issues in monitoring in utero drug exposure that urgently require research. These can be divided into research to definitively differentiate drug exposed and non-drug-exposed fetuses, determine the most efficient methods to routinely monitor women's drug use, and determine how these drug test results relate to neonatal and maternal outcomes. Research in this area is difficult and expensive to perform, but necessary to assess accurately drug effects on the fetus. By increasing our understanding of the physiological, biochemical and behavioral effects of gestational drug exposure, we may ultimately provide solutions for better drug prevention, treatment and a reduction in the number of drug-exposed children.
药物使用对全球人口的社会和经济影响持续增加，没有哪个地理、社会或文化群体能幸免。美国国家药物滥用研究所（NIDA）在为数不多的关于孕期滥用药物的大型调查之一中发现，5.5%的母亲报告在孕期使用过非法药物。由于孕期使用药物存在污名化以及随之而来的法律、伦理和经济问题，这些数字肯定被低估了。尽管不同国家的首选药物和给药途径有所不同，但我们最宝贵的资源——儿童，接触药物的发育影响是一个巨大的问题。子宫内药物暴露不仅会对胎儿的发育产生严重影响，还会对儿童的后期生活产生影响。与未接触药物的婴儿中27%相比，超过75%接触药物的婴儿有严重的健康问题。治疗受药物影响婴儿的费用是非受影响婴儿的两倍。滥用药物的母亲出现产科并发症的几率更高，包括胎盘功能不全、流产、宫内死亡以及传染病和性传播疾病发病率增加。对成瘾孕妇的治疗应是各国政府的高度优先事项。提高认识并改善我们在医学、法律和社会领域对药物滥用的理解，将使我们能够减少为这一重要人群提供治疗的障碍。准确识别子宫内药物暴露对母婴护理具有重要意义，但可能会引发棘手的法律问题。社会通过施加严厉的刑事处罚来阻碍产前护理。孕期母亲的药物使用情况可以通过尿液、汗液、唾液和/或毛发检测进行监测。传统上，子宫内药物暴露的检测是通过尿液检测完成的；然而，检测窗口期很短，仅反映分娩前几天的药物使用情况。通过检测替代样本（如新生儿胎粪和毛发）来监测暴露情况具有诸多优势，包括非侵入性采集以及在孕期更早阶段进行检测。在监测子宫内药物暴露方面存在许多未解决的问题，迫切需要开展研究。这些问题可分为以下几类：明确区分接触药物和未接触药物胎儿的研究、确定常规监测女性药物使用的最有效方法的研究，以及确定这些药物检测结果与新生儿和母亲结局之间关系的研究。这一领域的研究执行起来困难且昂贵，但对于准确评估药物对胎儿的影响是必要的。通过增进我们对孕期药物暴露的生理、生化和行为影响的理解，我们最终可能找到更好的药物预防和治疗方法，并减少接触药物儿童的数量。
