Viteri Oscar A, Soto Eleazar E, Bahado-Singh Ray O, Christensen Carl W, Chauhan Suneet P, Sibai Baha M
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center, Houston, Texas.
Department of Obstetrics and Gynecology, William Beaumont School of Medicine, Oakland University, Rochester, Michigan.
Am J Perinatol. 2015 Apr;32(5):405-16. doi: 10.1055/s-0034-1393932. Epub 2014 Dec 8.
Substance abuse in pregnancy remains a major public health problem. Fetal teratogenicity results from the effect of these substances during fetal development, particularly when used in combination. This review will focus on and attempt to clarify the existing literature regarding the association of substance abuse on the development of congenital anomalies and the long-term implications in exposed offspring.
Systematic review of available English literature using the PubMed database of all peer-reviewed articles on the subject.
A total of 128 articles were included in this review. Alcohol was the most common substance associated with fetal anomalies, particularly facial dysmorphisms and alterations in the central nervous system development. Adverse maternal environments associated with risky behaviors and lack of adequate prenatal care precludes the timely detection of fetal anomalies, confounding most studies linking causality. In addition, although methodological differences and limited availability of well-designed trials exist, substance abuse in pregnancy has been associated with adverse long-term outcomes in infant growth, behavior, cognition, language and achievement.
The literature summarized in this review suggests that drug exposure during pregnancy may increase the risk of congenital anomalies and long-term adverse effects in exposed children and adolescents. These conclusions must be tempered by the many confounders associated with drug use. A multidisciplinary approach is paramount for appropriate counseling regarding the known immediate and long-term risks of substance abuse in pregnancy.
孕期药物滥用仍然是一个主要的公共卫生问题。胎儿致畸性是这些物质在胎儿发育过程中产生的影响所致，尤其是联合使用时。本综述将聚焦并试图阐明关于药物滥用与先天性异常发育之间关联以及对暴露后代长期影响的现有文献。
使用PubMed数据库对所有关于该主题的同行评审英文文献进行系统综述。
本综述共纳入128篇文章。酒精是与胎儿异常最相关的物质，尤其是面部畸形和中枢神经系统发育改变。与危险行为及缺乏充分产前护理相关的不良母体环境妨碍了胎儿异常的及时检测，使大多数因果关系研究受到混淆。此外，尽管存在方法学差异且设计良好的试验有限，但孕期药物滥用与婴儿生长、行为、认知、语言和成就方面的不良长期结局相关。
本综述总结的文献表明，孕期药物暴露可能增加暴露儿童和青少年出现先天性异常及长期不良影响的风险。这些结论必须考虑到与药物使用相关的众多混杂因素。对于孕期药物滥用已知的近期和长期风险进行适当咨询，多学科方法至关重要。
