Quesada Odayme, Gotman Nathan, Howell Heather B, Funai Edmund F, Rounsaville Bruce J, Yonkers Kimberly A
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA.
J Matern Fetal Neonatal Med. 2012 Aug;25(8):1222-7. doi: 10.3109/14767058.2011.602143. Epub 2012 May 11.
Assess the relative effects of a variety of illicit and licit drugs on risk for adverse birth outcomes.
We used data from two large prospective investigations, and a novel analytic method, recursive partitioning class analysis to identify risk factors associated with preterm birth and delivering a small for gestational age infant.
Compared to cocaine and opiate non-users, cocaine users were 3.53 times as likely (95% CI: 1.65-7.56; p = 0.001) and opiate users 2.86 times as likely (95% CI: 1.11-7.36; p = 0.03) to deliver preterm. The odds of delivering a small for gestational age infant for women who smoked more than two cigarettes daily was 3.74, (95% CI: 2.47-5.65; p<0.0001) compared to women who smoked two or less cigarettes daily and had one previous child. Similarly, less educated, nulliparous women who smoked two or fewer cigarettes daily were 4.12 times as likely (95% CI: 2.04-8.34; p < 0.0001) to have a small for gestational age infant.
Among our covariates, prenatal cocaine and opiate use are the predominant risk factors for preterm birth; while tobacco use was the primary risk factor predicting small for gestational age at delivery. Multi-substance use did not substantially increase risk of adverse birth outcomes over these risk factors.
评估多种非法和合法药物对不良分娩结局风险的相对影响。
我们使用了来自两项大型前瞻性调查的数据，以及一种新颖的分析方法——递归划分分类分析，以识别与早产和分娩小于胎龄儿相关的风险因素。
与不使用可卡因和阿片类药物的人相比，使用可卡因的人早产的可能性是其3.53倍（95%置信区间：1.65 - 7.56；p = 0.001），使用阿片类药物的人早产的可能性是其2.86倍（95%置信区间：1.11 - 7.36；p = 0.03）。与每天吸烟两支或更少且有一个前孩子的女性相比，每天吸烟超过两支的女性分娩小于胎龄儿的几率为3.74（95%置信区间：2.47 - 5.65；p<0.0001）。同样，受教育程度较低、未生育且每天吸烟两支或更少香烟的女性分娩小于胎龄儿的可能性是其4.12倍（95%置信区间：2.04 - 8.34；p < 0.0001）。
在我们的协变量中，产前使用可卡因和阿片类药物是早产的主要风险因素；而吸烟是分娩时预测小于胎龄的主要风险因素。与这些风险因素相比，多物质使用并未大幅增加不良分娩结局的风险。
