ELNahas Gihan, Thibaut Florence
Neuropsychiatry Department, Ain Shams Medical School, Cairo 11591, Egypt.
University Hospital Cochin (Site Tarnier), University of Paris Cité, AP-HP, INSERM U1266, Institute of Psychiatry and Neurosciences, 75006 Paris, France.
J Clin Med. 2023 Mar 10;12(6):2175. doi: 10.3390/jcm12062175.
A significant increase in psychoactive drugs use was observed in women of childbearing age and during the perinatal period worldwide. Yet, the use of illicit drugs, alcohol and tobacco during pregnancy is a serious health risk for the mother, developing fetus and newborn.
This review of current trends and consequences of psychoactive substance use in the general population and in pregnant women was conducted using the English and French literature published during the years 2000 to 2022, supplemented by guidelines, meta-analyses and reviews.
According to current rates of prenatal substances use, it was calculated that 380,000 offspring were exposed to illicit substances, more than 500,000 to alcohol and over one million to tobacco during uterine life. Alarmingly, drug-related pregnancy-associated mortality has shown a staggering 190% rise between 2010 and 2019 in the USA. Different drugs of abuse, when used during pregnancy, increase the risk of stillbirth, neonatal abstinence syndrome and sudden infant death. Adverse effects on pregnancy include premature rupture of membranes, placental abruption, preterm birth, low birth space? weight and small-for-gestational-age infants. There is also an increased risk of morbidity and mortality for the pregnant women. Long-term negative adverse effects of perinatal exposure to substances also include a number of neurocognitive, behavioral and emotional dysfunctions in infants. Each type of substance has its own specificities, which will be briefly summarized.
All childbearing age women must be informed about the potential harm of the prenatal use of psychoactive substances and should be encouraged to stop their use when pregnancy is planned and, at least, when pregnancy is known. Questioning women about their alcohol consumption should be systematic at the first prenatal visit and then at every prenatal visit until delivery. Multidisciplinary prevention approaches as well as intervention measures targeted to each type of psychoactive substance can save mothers' lives and mitigate serious adversities to the offspring.
全球范围内，育龄妇女以及围产期妇女使用精神活性药物的情况显著增加。然而，孕期使用非法药物、酒精和烟草对母亲、发育中的胎儿和新生儿来说是严重的健康风险。
本综述利用2000年至2022年期间发表的英文和法文文献，并辅以指南、荟萃分析和综述，探讨了普通人群及孕妇使用精神活性物质的当前趋势和后果。
根据目前的产前物质使用比率计算，在子宫内生活期间，有38万后代接触非法物质，50多万接触酒精，100多万接触烟草。令人担忧的是，2010年至2019年期间，美国与药物相关的妊娠相关死亡率惊人地上升了190%。孕期使用不同的滥用药物会增加死产、新生儿戒断综合征和婴儿猝死的风险。对妊娠的不良影响包括胎膜早破、胎盘早剥、早产、低出生体重和小于胎龄儿。孕妇发病和死亡的风险也会增加。围产期接触物质的长期负面不良影响还包括婴儿出现一系列神经认知、行为和情感功能障碍。每种物质都有其自身特点，将简要总结如下。
必须告知所有育龄妇女孕期使用精神活性物质的潜在危害，并应鼓励她们在计划怀孕时，至少在知晓怀孕时停止使用。在首次产前检查时以及随后每次产前检查直至分娩，都应系统询问妇女的饮酒情况。针对每种精神活性物质的多学科预防方法以及干预措施可以挽救母亲的生命，并减轻对后代的严重不良影响。
