Smith Lynne M, LaGasse Linda L, Derauf Chris, Grant Penny, Shah Rizwan, Arria Amelia, Huestis Marilyn, Haning William, Strauss Arthur, Della Grotta Sheri, Liu Jing, Lester Barry M
Department of Pediatrics, David Geffen School of Medicine at UCLA and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502.
Pediatrics. 2006 Sep;118(3):1149-56. doi: 10.1542/peds.2005-2564.
Methamphetamine use among pregnant women is an increasing problem in the United States. Effects of methamphetamine use during pregnancy on fetal growth have not been reported in large, prospective studies. We examined the neonatal growth effects of prenatal methamphetamine exposure in the multicenter, longitudinal Infant Development, Environment and Lifestyle study.
DESIGN/METHOD: The Infant Development, Environment and Lifestyle study screened 13808 subjects at 4 clinical centers: 1618 were eligible and consented, among which 84 were methamphetamine exposed, and 1534 were unexposed. Those who were methamphetamine exposed were identified by self-report and/or gas chromatography-mass spectrometry confirmation of amphetamine and metabolites in infant meconium. Those who were unexposed denied amphetamine use and had a negative meconium screen. Both groups included prenatal alcohol, tobacco, or marijuana use, but excluded use of opiates, LSD, PCP or cocaine only. Neonatal parameters included birth weight and gestational age in weeks. One-way analysis of variance and linear-regression analyses were conducted on birth weight by exposure. The relationship of methamphetamine exposure and the incidence of small for gestational age was analyzed using multivariate logistic-regression analyses.
The methamphetamine exposed group was 3.5 times more likely to be small for gestational age than the unexposed group. Mothers who used tobacco during pregnancy were nearly 2 times more likely to have small-for-gestational-age infants. In addition, less maternal weight gain during pregnancy was more likely to result in a small-for-gestational-age infant. Birthweight in the methamphetamine exposed group was lower than the unexposed group.
These findings suggest that prenatal methamphetamine use is associated with fetal growth restriction after adjusting for covariates. Continued follow-up will determine if these infants are at increased risk for growth abnormalities in the future.
在美国，孕妇使用甲基苯丙胺的问题日益严重。大型前瞻性研究尚未报告孕期使用甲基苯丙胺对胎儿生长的影响。我们在多中心纵向开展的婴儿发育、环境与生活方式研究中，探讨了产前暴露于甲基苯丙胺对新生儿生长的影响。
设计/方法：婴儿发育、环境与生活方式研究在4个临床中心对13808名受试者进行了筛查：1618名符合条件并同意参与，其中84名暴露于甲基苯丙胺，1534名未暴露。通过自我报告和/或气相色谱-质谱法确认婴儿胎粪中存在苯丙胺及其代谢物来确定暴露于甲基苯丙胺的受试者。未暴露的受试者否认使用过苯丙胺且胎粪筛查呈阴性。两组均包括孕期使用酒精、烟草或大麻的情况，但仅排除使用阿片类药物、麦角酸二乙酰胺、苯环己哌啶或可卡因的情况。新生儿参数包括出生体重和孕周。对出生体重按暴露情况进行单因素方差分析和线性回归分析。使用多因素逻辑回归分析来分析甲基苯丙胺暴露与小于胎龄儿发生率之间的关系。
暴露于甲基苯丙胺的组出现小于胎龄儿的可能性是未暴露组的3.5倍。孕期吸烟的母亲生出小于胎龄儿的可能性几乎是其两倍。此外，孕期母亲体重增加较少更有可能导致生出小于胎龄儿。暴露于甲基苯丙胺组的出生体重低于未暴露组。
这些发现表明，在对协变量进行调整后，产前使用甲基苯丙胺与胎儿生长受限有关。持续随访将确定这些婴儿未来生长异常的风险是否增加。
