Lankenau Hospital, Department of Obstetrics and Gynecology, Wynnewood, PA 19096, USA.
J Addict Dis. 2010 Apr;29(2):175-91. doi: 10.1080/10550881003684723.
Substance abuse in pregnancy has increased over the past three decades in the United States, resulting in approximately 225,000 infants yearly with prenatal exposure to illicit substances. Routine screening and the education of women of child bearing age remain the most important ways to reduce addiction in pregnancy. Legal and illegal substances and their effect on pregnancy discussed in this review include opiates, cocaine, alcohol, tobacco, marijuana, and amphetamines. Most literature regarding opiate abuse is derived from clinical experience with heroin and methadone. Poor obstetric outcomes can be up to six times higher in patients abusing opiates. Neonatal care must be specialized to treat symptoms of withdrawal. Cocaine use in pregnancy can lead to spontaneous abortion, preterm births, placental abruption, and congenital anomalies. Neonatal issues include poor feeding, lethargy, and seizures. Mothers using cocaine require specialized prenatal care and the neonate may require extra supportive care. More than 50% of women in their reproductive years use alcohol. Alcohol is a teratogen and its effects can include spontaneous abortion, growth restriction, birth defects, and mental retardation. Fetal alcohol spectrum disorder can have long-term sequelae for the infant. Tobacco use is high among pregnant women, but this can be a time of great motivation to begin cessation efforts. Long-term effects of prenatal tobacco exposure include spontaneous abortion, ectopic pregnancy, placental insufficiency, low birth weight, fetal growth restriction, preterm delivery, childhood respiratory disease, and behavioral issues. Marijuana use can lead to fetal growth restriction, as well as withdrawal symptoms in the neonate. Lastly, amphetamines can lead to congenital anomalies and other poor obstetric outcomes. Once recognized, a multidisciplinary approach can lead to improved maternal and neonatal outcomes.
在过去的三十年中，美国的孕期物质滥用有所增加，导致每年约有 22.5 万名婴儿在孕期接触到非法物质。常规筛查和对育龄妇女的教育仍然是减少孕期成瘾的最重要方法。本综述讨论了包括阿片类药物、可卡因、酒精、烟草、大麻和安非他命在内的合法和非法物质及其对怀孕的影响。大多数关于阿片类药物滥用的文献都来源于对海洛因和美沙酮的临床经验。滥用阿片类药物的患者的不良产科结局发生率可能高达六倍。新生儿护理必须专门用于治疗戒断症状。孕期可卡因使用可导致自然流产、早产、胎盘早剥和先天畸形。新生儿问题包括喂养不良、嗜睡和癫痫发作。使用可卡因的母亲需要专门的产前护理，新生儿可能需要额外的支持性护理。超过 50%的育龄妇女饮酒。酒精是一种致畸物，其影响包括自然流产、生长受限、出生缺陷和智力迟钝。胎儿酒精谱系障碍会对婴儿造成长期的后遗症。孕妇吸烟率很高，但这也是开始戒烟的好时机。孕期吸烟的长期影响包括自然流产、宫外孕、胎盘功能不全、低出生体重、胎儿生长受限、早产、儿童呼吸道疾病和行为问题。大麻使用可导致胎儿生长受限以及新生儿戒断症状。最后，安非他命可导致先天畸形和其他不良产科结局。一旦被识别，多学科方法可以改善母婴结局。
