Growth of infants prenatally exposed to cocaine/crack: Comparison of a prenatal care and a no prenatal care sample
Growth of infants prenatally exposed to cocaine/crack: Comparison of a prenatal care and a no prenatal care sample
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DOI：
10.1542/peds.104.2.e18
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发表时间：
1999-08-01
期刊：
影响因子：
8
通讯作者：
Day, NL
中科院分区：
文献类型：
--
作者：
Richardson, GA;Hamel, SC;Day, NL
目标。由于这项研究涉及的方法学问题，目前还不可能就产前接触可卡因的影响得出明确的结论。这项研究旨在克服其中一些方法学问题，是一项前瞻性的纵向调查，目的是在两个样本中，一个有产前护理(PC)，一个没有产前护理(PC)，研究产前可卡因/可卡因暴露对新生儿生长的影响。PC样本中的295名妇女在每个三个月的末期就可卡因、可卡因、酒精、烟草、大麻和其他药物的使用情况进行了访谈。在没有产前护理(NPC)的样本中(n=98)，在分娩时就怀孕每三个月期间的药物使用情况进行了访谈。在这两个样本中，还获得了关于社会人口、生活方式、心理和社会支持特征的信息。这两个样本主要由低收入、单身和受过高中教育的女性组成。在女性中，PC样本中48%是黑人；NPC样本中81%是黑人。在产后住院期间，由对母体物质使用情况视而不见的项目护士对婴儿进行检查。在两个样本中，怀孕期间使用可卡因/可卡因的女性比怀孕期间不使用可卡因/可卡因的女性年龄更大，家庭收入更低，饮酒更多。此外，与PC样本中的女性相比，NPC样本中的女性更有可能是黑人，受教育程度较低，怀孕期间体重增加较少，饮酒更多，无论是否使用可卡因。在这两个样本中，在控制了可卡因使用的显著协变量后，在怀孕早期使用可卡因/可卡因可以预测胎龄、出生体重、身长和头围的减少。在样本比较中，鼻咽癌/可卡因组的后代显著小于PC/非可卡因组的后代，而PC/可卡因和鼻咽癌/可卡因组的后代没有差异。这些结果表明，在怀孕早期接触可卡因/可卡因会降低患有和不患有前列腺癌的妇女暴露于可卡因/可卡因的后代的宫内生长。各生长参数均受到影响，表现为对称性生长迟缓。PC的充分性不是决定暴露于可卡因和非暴露于可卡因的婴儿之间差异的重要因素。这些样本在整个儿童时期都在被跟踪，以确定产前接触可卡因/可卡因对生长是否有长期影响。
Objective. It has not been possible to draw firm conclusions about the effects of prenatal cocaine exposure because of methodologic problems involved in the conduct of this research. This study, designed to overcome some of these methodologic problems, is a prospective, longitudinal investigation of the effects of prenatal cocaine/crack exposure on neonatal growth in two samples, one with and one without prenatal care (PC).Methods. Women in the PC sample (n = 295) were interviewed at the end of each trimester about their use of cocaine, crack, alcohol, tobacco, marijuana, and other drugs. Women in the no prenatal care (NPC) sample (n = 98) were interviewed at delivery about their drug use during each trimester of pregnancy. In both samples, information was also obtained about sociodemographic, lifestyle, psychologic, and social support characteristics. Both samples consisted of women who were predominantly low income, single, and high school educated. Of the women, 48% in the PC sample were black; 81% in the NPC sample were black. Infants were examined during the postpartum hospital stay by project nurses who were blind to maternal substance use status.Results. Women in both samples who used cocaine/crack during pregnancy were older, had lower family incomes, and used more alcohol than did women who did not use cocaine/crack during pregnancy. In addition, women in the NPC sample were more likely to be black, less educated, gained less weight during pregnancy, and used more alcohol than did women in the PC sample, regardless of cocaine use. In both samples, cocaine/crack use during early pregnancy predicted reduced gestational age, birth weight, length, and head circumference, after controlling for the significant covariates of cocaine use. In a comparison of the samples, the offspring of the NPC/cocaine group were significantly smaller than were the offspring of the PC/no cocaine group, whereas the offspring of the PC/cocaine and NPC/cocaine groups did not differ.Conclusions. These results indicate that exposure to cocaine/crack during early pregnancy decreases the intrauterine growth of exposed offspring in women with and without PC. Each of the growth parameters was affected indicating symmetric growth retardation. The adequacy of PC was not a significant factor in determining the difference between cocaine-exposed and nonexposed infants. These samples are being followed throughout childhood to determine whether there are long-term effects of prenatal cocaine/crack exposure on growth.