Hutchings D E, Dow-Edwards D
Department of Developmental Psychobiology, Columbia University College of Physicians and Surgeons, New York, New York.
Clin Perinatol. 1991 Mar;18(1):1-22.
A traditional concern with drugs administered during pregnancy has been teratogenicity or the production of gross structural malformations. Beginning in the 1970s, it became increasingly evident that the issue of drug safety and risk assessment went far beyond structural defects. During the 1980s, the newly emerged research specialty of "developmental toxicology" came to encompass a wide range of adverse toxic outcomes that include not only birth defects but also neurobehavioral and other functional effects as well. Substances of use and abuse--the opiates, cocaine, and cannabis--have come to exemplify a diverse group of compounds that produce a broad spectrum of developmental outcomes. Unlike alcohol, neither the use of heroin nor methadone during pregnancy is associated with an increased risk of birth defects but both produce a neonatal abstinence syndrome that can persist for as long as 6 months; follow-up to preschool years suggests possible risk of attention deficit and problems of fine motor coordination. Methodologic weaknesses of opiate animal models, especially with respect of appropriate dosing schedules, have hampered meaningful extrapolation of these studies to human risk assessment. Given the renewed interest in methadone maintenance as an important therapeutic intervention to reduce exposure to the human immunodeficiency virus, better designed animal studies are needed urgently to assess developmental risk, but these must incorporate techniques that better model human pharmacokinetics. Animal models of early cocaine exposure, driven by human reports of serious risk to the fetus and newborn, have found reproductive hazard, risk of neurobehavioral effects as well as altered CNS function. Whereas animal studies need to explore routes of administration other than sc and ig, particularly the volatilized form of cocaine, to date it appears that the processes of somatic growth and morphogenesis in rodents are not as sensitive to cocaine as is the functional development of the CNS. Finally, animal studies of cannabis have taught us some major methodologic and interpretive lessons for the continuing development and refinement of animal models of drugs of abuse. Of particular importance is that poorly controlled experiments that do not adequately consider the confounding influences of maternal toxicity, both prenatally and postnatally, are likely to yield a high rate of false-positive results. This is well illustrated by those studies of cannabis that antedated the current concern for pair-feeding and surrogate fostering. Nearly all of the studies that failed to include nutritional and fostering controls found neurobehavioral effects that included changes in activity as well as impairments in learning and memory.(ABSTRACT TRUNCATED AT 400 WORDS)
孕期用药的一个传统关注点一直是致畸性,即产生严重的结构畸形。从20世纪70年代开始,药物安全性和风险评估问题远远超出结构缺陷这一点变得越来越明显。在20世纪80年代,新兴的“发育毒理学”研究专业开始涵盖广泛的不良毒性后果,这些后果不仅包括出生缺陷,还包括神经行为和其他功能影响。使用和滥用的物质——阿片类药物、可卡因和大麻——已成为产生广泛发育结果的不同化合物群体的典型代表。与酒精不同,孕期使用海洛因或美沙酮均与出生缺陷风险增加无关,但两者都会产生持续长达6个月的新生儿戒断综合征;对学龄前儿童的随访表明存在注意力缺陷和精细运动协调问题的可能风险。阿片类动物模型的方法学弱点,尤其是在适当给药方案方面,阻碍了将这些研究有意义地外推至人类风险评估。鉴于对美沙酮维持治疗作为减少人类免疫缺陷病毒暴露的重要治疗干预措施重新产生兴趣,迫切需要设计更好的动物研究来评估发育风险,但这些研究必须纳入能更好模拟人类药代动力学的技术。受人类关于胎儿和新生儿严重风险报告的驱动,早期可卡因暴露的动物模型发现了生殖危害、神经行为影响风险以及中枢神经系统功能改变。虽然动物研究需要探索皮下注射和灌胃以外的给药途径,特别是可卡因的挥发形式,但迄今为止,啮齿动物的体细胞生长和形态发生过程似乎对可卡因的敏感性不如中枢神经系统的功能发育。最后,大麻的动物研究为滥用药物动物模型的持续发展和完善给我们提供了一些主要的方法学和解释方面的教训。特别重要的是,控制不佳的实验如果没有充分考虑产前和产后母体毒性的混杂影响,很可能会产生高比例的假阳性结果。这在当前对配对喂养和替代寄养的关注之前的那些大麻研究中得到了很好的体现。几乎所有未包括营养和寄养对照的研究都发现了神经行为影响,包括活动变化以及学习和记忆障碍。(摘要截短至400字)