Jones H E, Balster R L
Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, USA.
Obstet Gynecol Clin North Am. 1998 Mar;25(1):153-67. doi: 10.1016/s0889-8545(05)70363-6.
Information from a variety of sources suggests the possibility of adverse effects of maternal inhalant abuse, although a well-controlled, prospective study in this area has not been conducted. One source of this concern is the data from occupational exposure to some of the abused solvents, specifically toluene and TCE, with numerous reports suggesting increased spontaneous abortion and fetal malformations. There are also data suggesting decreased fertility and an increased risk for spontaneous abortion in health care workers exposed to nitrous oxide. The relevance of these studies to problems of inhalant abuse is not clear. Although the chemicals involved are the same, there are many differences in the exposure parameters, the populations exposed, and the types of associated risk factors. Nonetheless, there are more than 100 cases reported in the literature of children born to solvent-abusing mothers. Many of these children were small at birth, and some have craniofacial abnormalities not unlike that seen in children with FAS. In the few studies reporting the findings of follow-up in these children, some evidence has been obtained for retardation in growth and development and for residual deficits in cognitive, speech, and motor skills. Clearly, more research is needed to rule out the concomitant risk factors and to identify specific chemicals and patterns of use associated with adverse effects. Animal studies provide more direct evidence that prenatal exposure to toluene or TCE can produce reduced birth weights, occasional skeletal abnormalities, and delayed neurobehavioral development, even under conditions designed to mimic inhalant abuse patterns. Additional research is needed to identify other chemicals with adverse effects, critical periods of exposure, effects of combinations of inhalants, or interactions with drugs of abuse. The research literature seems sufficient to alert clinicians to possible problems in patients who abuse inhalants while pregnant. Diagnosis and good prenatal care for these women are important. The evidence for neonatal withdrawal is limited at this time; however, infants born to women who have recently used inhalants should be observed carefully for an alcohol-like withdrawal syndrome. Although it is not possible to link a specific birth defect or developmental problem in the child of an inhalant abuser to prenatal exposure to a specific chemical, it is clear that inhalant abuse and its associated lifestyle place children at increased risk. A wider appreciation of this is needed among health care professionals and the general public.
来自各种来源的信息表明，母亲滥用吸入剂可能会产生不良影响，不过尚未在该领域开展一项控制良好的前瞻性研究。这种担忧的一个来源是职业接触某些被滥用溶剂的数据，特别是甲苯和三氯乙烯，大量报告表明自然流产和胎儿畸形有所增加。也有数据表明，接触氧化亚氮的医护人员生育能力下降，自然流产风险增加。这些研究与吸入剂滥用问题的相关性尚不清楚。虽然所涉及的化学物质相同，但在接触参数、接触人群以及相关风险因素类型方面存在许多差异。尽管如此，文献中报道了100多例母亲滥用溶剂的儿童出生案例。这些儿童中有许多出生时体重较轻，有些存在与胎儿酒精谱系障碍（FAS）患儿类似的颅面异常。在少数报告这些儿童随访结果的研究中，已获得一些证据表明其生长发育迟缓以及认知、言语和运动技能存在残留缺陷。显然，需要开展更多研究以排除伴随的风险因素，并确定与不良影响相关的特定化学物质和使用模式。动物研究提供了更直接的证据，表明即使在旨在模拟吸入剂滥用模式的条件下，产前接触甲苯或三氯乙烯也会导致出生体重降低、偶尔出现骨骼异常以及神经行为发育延迟。需要开展更多研究以确定其他具有不良影响的化学物质、关键接触期、吸入剂组合的影响或与滥用药物的相互作用。研究文献似乎足以提醒临床医生注意怀孕时滥用吸入剂的患者可能存在的问题。对这些女性进行诊断和良好的产前护理很重要。目前关于新生儿戒断的证据有限；然而，近期使用过吸入剂的女性所生婴儿应仔细观察是否出现类似酒精的戒断综合征。虽然无法将吸入剂滥用者孩子的特定出生缺陷或发育问题与产前接触特定化学物质联系起来，但很明显，吸入剂滥用及其相关生活方式会使儿童面临更高风险。医护人员和普通公众需要更广泛地认识到这一点。
