Wheeler S F
Department of Family and Community Medicine, University of Louisville School of Medicine, Kentucky.
Prim Care. 1993 Mar;20(1):191-207.
Use and abuse of both licit and illicit drugs is common. Although certain variables can appropriately serve as markers for increased risk, the possibility of substance abuse should be considered in all pregnant women. Alcohol is the leading identified cause of teratogenesis by drugs or environmental agents; most other drugs of abuse do not increase the risk of congenital malformations on a large scale. Substance abuse can produce significant degrees of toxicity in both pregnant women and their offspring. Screening and counseling of pregnant women concerning past and present use of tobacco, alcohol, and illicit drugs should be routine. Prenatal care must include increased surveillance for drug-related complications; coordinated, comprehensive, family-oriented drug treatment; and social services. Rehabilitation and support efforts should continue after delivery and address issues that lead to and maintain patterns of abuse. The drug-exposed neonate must be anticipated and evaluated with a knowledge of the maternal drug abuse history and specific drug risks, including neonatal abstinence syndrome. Continuing care of the child should address the increased risk of developmental and behavioral problems from both prenatal exposures and continuing socioenvironmental barriers.
合法及非法药物的使用与滥用都很常见。尽管某些变量可作为风险增加的恰当标志，但所有孕妇都应考虑药物滥用的可能性。酒精是已明确的由药物或环境因素导致致畸的首要原因；大多数其他滥用药物并不会大规模增加先天性畸形的风险。药物滥用会在孕妇及其后代中产生显著程度的毒性。对孕妇进行关于过去和当前烟草、酒精及非法药物使用情况的筛查和咨询应成为常规操作。产前护理必须包括加强对药物相关并发症的监测；协调、全面、以家庭为导向的药物治疗；以及社会服务。产后应继续进行康复和支持工作，并解决导致和维持滥用模式的问题。必须根据产妇药物滥用史和特定药物风险（包括新生儿戒断综合征）来预期和评估药物暴露的新生儿。对儿童的持续护理应解决产前暴露和持续的社会环境障碍所带来的发育和行为问题风险增加的问题。
