Garrison Laura, Leeman Lawrence, Savich Renate D, Gutierrez Hilda, Rayburn William F, Bakhireva Ludmila N
J Reprod Med. 2016 Jul-Aug;61(7-8):311-319.
To evaluate the effects of prenatal polydrug and exclusive opioid use on fetal growth outcomes.
This analysis relied on the data obtained from two prospective cohorts at the University of New Mexico. For both cohorts, pregnant women were recruited during one of their prenatal care visits and followed up to delivery. The merged sample included 59 polydrug users, 22 exclusive opioid users, and 278 abstinent controls. Continuous growth measures (birth weight, height, occipital frontal circumference [OFC], and corresponding sex-specific percentiles) were compared by ANOVA and ANCOVA in bivariate and multivariable analyses, respectively. Categorical outcomes (prevalence of small-for-gestational age [SGA] for weight, length, and OFC) were compared among groups by Chi-square and multivariable logistic regression analyses..
The sample included a large proportion of ethnic minorities (78.8% Hispanic) and patients with low educational attainment (68% ≤ high school). The risk of microcephaly (OFC<10 percentile) was significantly greater in the polydrug (OR=4.7; 95% CI: 2.0; 10.8) and exclusive opioid (OR=2.8; 95% CI: 1.0; 8.1) groups compared to abstinent controls.
Given that microcephaly is often associated with serious neurocognitive and behavioral deficits later in life, our finding of 49.2% incidence of microcephaly among polydrug users is alarming and requires further investigation.
评估产前多种药物联合使用及单纯使用阿片类药物对胎儿生长结局的影响。
本分析依赖于从新墨西哥大学的两个前瞻性队列中获得的数据。对于这两个队列，孕妇在产前检查期间的某一次就诊时被招募，并随访至分娩。合并后的样本包括59名多种药物使用者、22名单纯阿片类药物使用者和278名戒断对照者。在双变量和多变量分析中，分别通过方差分析（ANOVA）和协方差分析（ANCOVA）比较连续生长指标（出生体重、身高、枕额径[OFC]以及相应的性别特异性百分位数）。通过卡方检验和多变量逻辑回归分析比较各组间分类结局（体重、身长和枕额径小于胎龄[SGA]的患病率）。
样本中包括很大比例的少数民族（78.8%为西班牙裔）和低教育程度患者（68%≤高中）。与戒断对照者相比，多种药物使用者组（比值比[OR]=4.7；95%置信区间[CI]：2.0；10.8）和单纯阿片类药物使用者组（OR=2.8；95%CI：1.0；8.1）患小头畸形（枕额径<第10百分位数）的风险显著更高。
鉴于小头畸形通常与生命后期严重的神经认知和行为缺陷相关，我们发现多种药物使用者中小头畸形的发生率为49.2%，这一结果令人担忧，需要进一步调查。
