Department of Environmental Health Sciences, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
Neurotoxicol Teratol. 2012 May-Jun;34(3):303-10. doi: 10.1016/j.ntt.2012.02.001. Epub 2012 Mar 3.
3,4-methylenedioxymethamphetamine (MDMA) or "Ecstasy" is one of the most widely used illicit recreational drugs among young adults. MDMA is an indirect monoaminergic agonist and reuptake inhibitor that primarily affects the serotonin system. Preclinical studies in animals have found prenatal exposure related to neonatal tremors and long-term learning and memory impairments. To date, there are no prospective studies of the sequelae of prenatal exposure to MDMA in humans, despite concerns about its potential for harmful effects to the fetus. The present study is the first to prospectively identify MDMA-using women during pregnancy and to document patterns and correlates of use with neonatal and early infancy outcomes of offspring. All mothers and infants were prospectively recruited through the Case Western Reserve University (CWRU) and University of East London (UEL) Drugs and Infancy Study (DAISY) that focused on recreational drug use in pregnant women. Women were interviewed about substance use prior to and during pregnancy and infants were seen at 1 and 4 months using standardized, normative assessments of neonatal behavior, and cognitive and motor development, including the NICU Network Neurobehavioral Scale (NNNS), the Bayley Mental and Motor Development Scales (MDI, PDI), and the Alberta Infant Motor Scales (AIMS). The sample was primarily middle class with some university education and in stable partner relationships. The majority of women recruited had taken a number of illicit drugs prior to or during pregnancy. Group differences between those polydrug using women who had specifically used MDMA during pregnancy (n=28) and those who had not (n=68) were assessed using chi-square and t-tests. MDMA and other drug effects were assessed through multiple regression analyses controlling for confounding variables. Women who used MDMA during pregnancy had fewer prior births and more negative sequelae associated with their drug use, including more health, work, and social problems. MDMA exposed infants differed in sex ratio (more male births) and had poorer motor quality and lower milestone attainment at 4 months, with a dose-response relationship to amount of MDMA exposure. These findings suggest risk to the developing infant related to MDMA exposure and warrant continued follow-up to determine whether early motor delays persist or resolve.
3,4-亚甲二氧基甲基苯丙胺（MDMA）或“摇头丸”是年轻成年人中使用最广泛的非法娱乐药物之一。MDMA 是一种间接单胺能激动剂和再摄取抑制剂，主要影响 5-羟色胺系统。动物的临床前研究发现，产前接触与新生儿震颤和长期学习记忆损伤有关。迄今为止，尽管人们担心 MDMA 对胎儿有潜在的有害影响，但仍没有关于人类产前接触 MDMA 后遗症的前瞻性研究。本研究首次前瞻性地确定了怀孕期间使用 MDMA 的女性，并记录了使用模式及其与后代新生儿和婴儿早期结局的相关性。所有母亲和婴儿均通过凯斯西储大学（CWRU）和东伦敦大学（UEL）的药物和婴儿研究（DAISY）前瞻性招募，该研究侧重于孕妇的娱乐性药物使用。在怀孕前和怀孕期间，对妇女进行了关于物质使用的访谈，并在 1 个月和 4 个月时使用新生儿行为的标准化、规范评估以及认知和运动发育对婴儿进行了评估，包括新生儿重症监护病房网络神经行为量表（NNNS）、贝利精神和运动发育量表（MDI、PDI）和阿尔伯塔婴儿运动量表（AIMS）。该样本主要是中产阶级，有一些大学教育背景，并且处于稳定的伴侣关系中。大多数招募的女性在怀孕前或怀孕期间都使用过多种非法药物。通过卡方检验和 t 检验评估了在怀孕期间具体使用 MDMA 的多药使用女性（n=28）与未使用 MDMA 的女性（n=68）之间的组间差异。使用多元回归分析控制混杂变量后评估了 MDMA 和其他药物的影响。在怀孕期间使用 MDMA 的女性生育次数较少，与药物使用相关的不良后果更多，包括更多的健康、工作和社会问题。暴露于 MDMA 的婴儿在性别比例（更多男性出生）和 4 个月时的运动质量较差且里程碑完成率较低方面存在差异，并且与 MDMA 暴露量存在剂量反应关系。这些发现表明与 MDMA 暴露相关的发育中婴儿的风险，并需要进一步随访以确定早期运动迟缓是否持续或缓解。
