Kosofsky B E
Laboratory of Molecular and Developmental Neuroscience, Massachusetts General Hospital-East, Charlestown 02129, USA.
Semin Speech Lang. 1998;19(2):109-21. doi: 10.1055/s-2008-1064040.
Gestational exposure to licit drugs of abuse such as alcohol and cigarettes, and illicit drugs of abuse such as marijuana, cocaine, and opiates is the single largest, preventable cause of in utero developmental compromise of infants in the United States today. Clinical and preclinical data suggest that cocaine may act as a behavioral teratogen, a drug capable of altering fetal brain development and subsequent function. Although many children exposed to cocaine in utero have normal development, some subset of infants, especially those who have sustained more significant prenatal exposures, are at risk for developmental compromise. There does not appear to be one outcome, but a spectrum of outcomes, which may relate to individual genetic differences in mothers and infants, to the specifics of the pregnant woman's cocaine habit, as well as to the richness of the postnatal environment. Alterations of arousal and habituation are evident in some cocaine-exposed neonates, especially following greater in utero exposures. Subtle but profoundly important behavioral deficits may persist, as recent data suggests that some cocaine-exposed children may have particular difficulty modulating attention, impulsivity, and responsivity, which are critically challenged in classroom settings. The goals of this article are to present concepts required to better understand cocaine-induced alterations in neuro-development, to outline mechanisms that may underlie such changes, and to discuss the potential clinical consequences of such alterations.
孕期接触酒精和香烟等合法滥用药物，以及大麻、可卡因和阿片类药物等非法滥用药物，是当今美国婴儿子宫内发育受损的最大单一可预防原因。临床和临床前数据表明，可卡因可能是一种行为致畸剂，即一种能够改变胎儿大脑发育及后续功能的药物。虽然许多在子宫内接触可卡因的儿童发育正常，但有一部分婴儿，尤其是那些在产前接触程度更严重的婴儿，有发育受损的风险。似乎不存在单一的结果，而是一系列的结果，这可能与母婴个体的基因差异、孕妇可卡因成瘾的具体情况以及产后环境的丰富程度有关。在一些接触可卡因的新生儿中，尤其是在子宫内接触程度更高之后，觉醒和习惯化的改变很明显。细微但极其重要的行为缺陷可能会持续存在，因为最近的数据表明，一些接触可卡因的儿童在调节注意力、冲动性和反应性方面可能会有特别的困难，而这些在课堂环境中会受到严峻挑战。本文的目的是介绍更好地理解可卡因引起的神经发育改变所需的概念，概述可能是这些变化基础的机制，并讨论这些改变的潜在临床后果。
