Burkett G, Yasin S Y, Palow D, LaVoie L, Martinez M
Department of Obstetrics and Gynecology, University of Miami, FL.
Am J Obstet Gynecol. 1994 Aug;171(2):372-8; discussion 378-9. doi: 10.1016/s0002-9378(94)70037-0.
The purpose of this study was to determine how cocaine and crack binging affected perinatal complications.
Between Jan. 1 and Dec. 31, 1989, patterns of cocaine-crack binging and perinatal consequences in 905 pregnant women from multiethnic, multiracial, inner-city populations were studied. Binging cycles reflect the chaotic lifestyle of drug abuse and multiple obstetric at-risk cofactors as integral parts of binging and are more accurately defined than amount of drugs consumed.
Binging patterns in 905 pregnant women who use cocaine-crack as their primary drug were as follows: group 1, 78 women with "erratic" binging that is variable in intervals, duration, and amounts but who are very aggressive drug seekers; group 2, 67 women who binged daily; group 3, 760 women who binged in cycles at 3-, 5-, 7-, or > 7-day intervals. Binges ranged from 26.4 to 34.4 hours. Complications were proportional to the frequency of binging, (linear association p < 0.0007). The prematurity rate in group 1 was unexpectedly as high as that in group 2 (35.9% vs 34.3%). Acute problems (vaginal bleeding 21.8%, abruptio placentae 14.3%, stillbirths 20.5%) were most significant in group 1, while chronic problems (small-for-gestational-age infants 32.8%, systemic infections 31.3%, anemia 35.6%, and low maternal weight [< 100 pounds] 32.8%) were more significant in groups 2 and 3. Odds ratios show that prematurity, abruptio placentae, and vaginal bleeding were two to three times more likely to occur if test results for cocaine were positive at delivery. However, in group 1 the likelihood of abruptio placentae was unchanged whether toxicologic test results were positive (14.3%) or negative (14.0%), reflecting the role of cofactors in binging.
Erratic use of cocaine-crack results in perinatal complications that are as severe as those occurring with daily binging but the patterns differ. Cofactors play a significant role in outcomes.
本研究旨在确定可卡因和快克可卡因的暴饮暴食如何影响围产期并发症。
在1989年1月1日至12月31日期间，对来自多民族、多种族城市中心地区的905名孕妇的可卡因-快克可卡因暴饮暴食模式及围产期后果进行了研究。暴饮暴食周期反映了药物滥用的混乱生活方式以及多种产科风险协同因素，这些是暴饮暴食的组成部分，并且比所摄入药物的量更能准确界定。
以可卡因-快克可卡因为主要药物的905名孕妇的暴饮暴食模式如下：第1组，78名孕妇有“不规律”的暴饮暴食，其间隔、持续时间和摄入量各不相同，但她们是非常积极的药物寻求者；第2组，67名孕妇每天暴饮暴食；第3组，760名孕妇以3天、5天、7天或>7天的间隔周期性暴饮暴食。暴饮暴食持续时间为26.4至34.4小时。并发症与暴饮暴食频率成正比（线性关联p<0.0007）。第1组的早产率意外地与第2组一样高（35.9%对34.3%）。急性问题（阴道出血21.8%、胎盘早剥14.3%、死产20.5%）在第1组最为显著，而慢性问题（小于胎龄儿32.8%、全身感染31.3%、贫血35.6%以及低体重产妇[<100磅]32.8%）在第2组和第3组更为显著。优势比显示，如果分娩时可卡因检测结果为阳性，早产、胎盘早剥和阴道出血发生的可能性要高出两到三倍。然而，在第1组中，无论毒理学检测结果为阳性（14.3%）还是阴性（14.0%），胎盘早剥的可能性都没有变化，这反映了协同因素在暴饮暴食中的作用。
不规律使用可卡因-快克可卡因会导致与每日暴饮暴食同样严重的围产期并发症，但模式有所不同。协同因素在结果中起重要作用。
