Messiah Sarah E, Miller Tracie L, Lipshultz Steven E, Bandstra Emmalee S
Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
Prog Pediatr Cardiol. 2011 Jan 1;31(1):59-65. doi: 10.1016/j.ppedcard.2010.11.010.
The literature strongly suggests that prenatal exposure to certain medications and substances does not cause major malformations in early childhood. However, these exposures may have far-reaching latent health effects, such as restricted growth, hypertension, and cardiovascular events in adulthood. We reviewed the literature to identify the effects of prenatal cocaine exposure on growth and the risk of cardiovascular and metabolic disease in late adolescence and early adulthood by examining studies that were published in peer-reviewed English-language journals from 1990 through 2009 and indexed in MEDLINE. We found that animal and clinical studies of the influence of prenatal cocaine exposure on child and adolescent growth and the subsequent development of myocardial and cardiometabolic disease risk factors are few and inconclusive. Studies support the hypothesis that vascular and hemodynamic functions are partially programmed in early life and thus substantially influence vascular aging and arterial stiffening in later life. Sub-optimal fetal nutrition and growth may increase blood pressure and the development of cardiovascular and metabolic disease in late life. How prenatal cocaine and other drug exposure effects this relationship is currently unknown. Despite high rates of cocaine and other drug use during pregnancy (up to 18% in some studies), little is known about the health effects of prenatal cocaine exposure in adolescence and early adulthood. The few studies of early growth deficits persisting into adolescence are inconclusive. The literature provides little information on how exposed children grow into adulthood and about their subsequent risk of cardiometabolic and vascular disease.
文献有力地表明，孕期接触某些药物和物质不会在儿童早期导致严重畸形。然而，这些接触可能会产生深远的潜在健康影响，比如成年期生长受限、高血压和心血管疾病。我们回顾了文献，通过查阅1990年至2009年发表在同行评审英文期刊且被MEDLINE收录的研究，来确定孕期接触可卡因对青少年晚期和成年早期生长以及心血管和代谢疾病风险的影响。我们发现，关于孕期接触可卡因对儿童和青少年生长以及随后心肌和心脏代谢疾病风险因素发展的影响，动物和临床研究较少且尚无定论。研究支持这样的假设，即血管和血液动力学功能在生命早期部分地被编程，因此对后期的血管衰老和动脉僵硬有重大影响。胎儿营养和生长欠佳可能会增加晚年患高血压以及心血管和代谢疾病的风险。目前尚不清楚孕期接触可卡因和其他药物如何影响这种关系。尽管孕期可卡因和其他药物使用率很高（在一些研究中高达18%），但对于孕期接触可卡因对青少年和成年早期健康的影响却知之甚少。少数关于持续到青少年期的早期生长缺陷的研究尚无定论。文献几乎没有提供关于受影响儿童如何成长至成年以及他们随后患心脏代谢和血管疾病风险的信息。
