Lamy S, Thibaut F
CHU de Rouen, Inserm CIC 0204, UFR de médecine, Rouen, France.
Encephale. 2010 Feb;36(1):33-8. doi: 10.1016/j.encep.2008.12.009. Epub 2009 Apr 23.
All around the world, the potential consequences of the increasing use of psychoactive substances during pregnancy are a major public health concern. It is estimated that 20 to 30% of pregnant women use tobacco, 15% use alcohol, 3 to 10% use cannabis and 0.5 to 3% use cocaine. The estimation of tobacco consumption during pregnancy is better known as compared with alcohol and substance use prevalence during pregnancy, which remains under estimated or unknown. For example, in France, the prevalence of cannabis and cocaine use during pregnancy is unknown. In general, the prevalence of drug or alcohol use during pregnancy is estimated by extrapolating data from epidemiological studies conducted in the general population (in France or in other countries). However, drug or alcohol use in the general population may dramatically vary from one country to another. Even if some studies have reported the prevalence of alcohol or substance use in different countries around the world, most of them were based on the mother's interview. In most cases, the mother did not report exactly the amount of drugs or alcohol used. Further studies measuring alcohol or substance use in the mother's blood, hair or in the newborn's meconium are needed. In addition, different methodologies have been used in the literature (different types of interview, with or without biological measurements; different subjects included (in- or out-pregnant women, psychiatric comorbidities or not, different economic status, etc). Despite these methodological biases, the prevalence of drug or alcohol use increases in pregnant women, and in most cases, several drugs are associated. Most of the studies have used structured or semi-structured interviews such as the addiction severity index (ASI) or the alcohol use disorders identification test (AUDIT) to assess alcohol or drug consumption. In addition, the identification of risk factors for substance or alcohol use during pregnancy would allow the early detection of these high-risk pregnancies. Environmental factors such as low economic status or marital status may play an important role. Personality disorders may also contribute to substance or alcohol use during pregnancy. In fact, in most studies the quality of the obstetrical survey is lower in pregnant women using drugs or alcohol but it remains difficult to describe a specific at-risk profile in these pregnant women. Consumption of alcohol or of one or more psychoactive substances during pregnancy may have serious consequences on the pregnancy and on the child's development. Fetal alcoholism syndrome is the main etiology of mental retardation in France. We need to improve our knowledge of alcohol and substance use during pregnancy in order to target information for prevention campaigns and to implement specific mother and child medical care in high-risk populations.
在全球范围内，孕期精神活性物质使用增加所带来的潜在后果是一个重大的公共卫生问题。据估计，20%至30%的孕妇吸烟，15%饮酒，3%至10%使用大麻，0.5%至3%使用可卡因。与孕期酒精和物质使用流行率相比，孕期吸烟情况的估计更为人所知，而酒精和物质使用流行率仍被低估或未知。例如，在法国，孕期大麻和可卡因使用的流行率未知。一般来说，孕期药物或酒精使用的流行率是通过推断在普通人群（法国或其他国家）中进行的流行病学研究数据来估计的。然而，普通人群中的药物或酒精使用情况在不同国家可能有很大差异。即使一些研究报告了世界不同国家酒精或物质使用的流行率，但大多数研究是基于对母亲的访谈。在大多数情况下，母亲并未准确报告所使用的药物或酒精量。需要进一步开展测量母亲血液、头发或新生儿胎粪中酒精或物质使用情况的研究。此外，文献中使用了不同的方法（不同类型的访谈，有无生物测量；纳入不同的研究对象（孕妇或非孕妇、有无精神疾病共病、不同经济状况等）。尽管存在这些方法上的偏差，但孕妇药物或酒精使用的流行率仍在上升，而且在大多数情况下，几种药物是同时使用的。大多数研究使用结构化或半结构化访谈，如成瘾严重程度指数（ASI）或酒精使用障碍识别测试（AUDIT）来评估酒精或药物消费情况。此外，识别孕期物质或酒精使用的风险因素将有助于早期发现这些高危妊娠。环境因素如经济地位低或婚姻状况可能起重要作用。人格障碍也可能导致孕期物质或酒精使用。事实上，在大多数研究中，使用药物或酒精的孕妇产科检查质量较低，但仍难以描述这些孕妇的具体高危特征。孕期饮酒或使用一种或多种精神活性物质可能对妊娠和儿童发育产生严重后果。胎儿酒精综合征是法国智力迟钝的主要病因。我们需要提高对孕期酒精和物质使用情况的认识，以便针对预防宣传提供信息，并在高危人群中实施特定的母婴医疗护理。
