Jacobson J L, Jacobson S W, Sokol R J, Martier S S, Ager J W, Shankaran S
Psychology Department, Wayne State University, Detroit, MI 48202.
J Pediatr. 1994 May;124(5 Pt 1):757-64. doi: 10.1016/s0022-3476(05)81371-x.
To compare the effects of prenatal exposure to alcohol, smoking, and illicit drugs on birth size.
Prospective, longitudinal correlational study, with statistical control for confounding.
Four hundred seventeen black infants. Mothers recruited at first prenatal clinic visit on the basis of moderate-to-heavy use of alcohol or cocaine or both, plus a 5% random sample of lower-level drinkers and abstainers.
Alcohol, smoking, opiates, and cocaine were each correlated with smaller birth weight, length, and head circumference (median r = -0.21; p < 0.001). However, when all four substances, gestational age, and six covariates were controlled statistically, birth weight related only to alcohol and smoking (p < 0.05), length only to alcohol (p < 0.05), and head circumference only to opiates (p < 0.01). Although smoking affected birth weight at all levels of exposure, a larger deficit was seen in relation to heavy drinking (509 gm) than to heavy smoking (269 gm). Alcohol and smoking did not affect birth size synergistically, and their effects were seen primarily in infants of women more than 30 years of age.
The association of reduced birth weight and length with illicit drug use may be a consequence of simultaneous exposure of the fetus to alcohol and smoking. Opiate exposure is specifically related to reduced head circumference, and the effect of cocaine on birth size is primarily an indirect consequence of shorter gestation and poorer maternal nutrition.
比较孕期接触酒精、吸烟和非法药物对出生时大小的影响。
前瞻性纵向相关性研究，对混杂因素进行统计学控制。
417名黑人婴儿。母亲们是在首次产前诊所就诊时招募的，入选标准为中度至重度饮酒或使用可卡因或两者皆有，外加5%的轻度饮酒者和戒酒者的随机样本。
酒精、吸烟、阿片类药物和可卡因均与较低的出生体重、身长和头围相关（中位数r = -0.21；p < 0.001）。然而，当对所有四种物质、孕周和六个协变量进行统计学控制后，出生体重仅与酒精和吸烟有关（p < 0.05），身长仅与酒精有关（p < 0.05），头围仅与阿片类药物有关（p < 0.01）。尽管吸烟在所有暴露水平下都会影响出生体重，但与重度饮酒（509克）相比，重度吸烟（269克）导致的体重不足更大。酒精和吸烟对出生大小没有协同影响，其影响主要见于30岁以上女性的婴儿。
出生体重和身长降低与非法药物使用之间的关联可能是胎儿同时接触酒精和吸烟的结果。阿片类药物暴露与头围减小有特定关系，可卡因对出生大小的影响主要是妊娠缩短和母亲营养较差的间接后果。
