SUBSTANCE USE IN PREGNANCY - DO WE CARE
SUBSTANCE USE IN PREGNANCY - DO WE CARE
复制标题
DOI：
10.1111/j.1651-2227.1994.tb13386.x
复制
发表时间：
1994-11-01
期刊：
影响因子：
3.8
通讯作者：
HOGERZEIL, HV
中科院分区：
文献类型：
--
作者：
BOER, K;SMIT, BJ;HOGERZEIL, HV
两个队列的物质使用的妇女进行了回顾性比较。从1969年至1979年，在92名使用多种药物的妇女（排除一对双胞胎）中发现了非常高的围产期死亡率（PMR 9.8%）。早产发生在所有怀孕的25%和30%的儿童出生体重低于第10百分位数。19名仅使用海洛因的妇女有更差的胎儿结局（PMR 32%，早产47%，出生体重<10%的42%）。这些结果导致了严格的监督制度。在1980-1989年期间，240名妇女（不包括4对双胞胎）在16周后分娩。总胎儿丢失率降至2.1%，PMR降至0.4%，与对照组结果相似。然而，22%的妇女仍然在37周前分娩，27%的妇女分娩的孩子<10%。使用美沙酮的妇女能够在怀孕期间将剂量减半，16人解毒。第二组药物使用者的多变量分析表明，新生儿戒断综合征，而不是（注册）阿片类药物的使用量，与出生体重较低。不进行产前护理与怀孕时间较短有关。包括对照组在内的多变量分析显示，出生体重（低345克）与物质使用有显著关系。此外，头围小了0.8厘米。然而，怀孕的时间长短与吸烟有关。这项研究表明，很难使物质使用者参加产前护理，但也表明，妇女应对产前护理减少物质的摄入量。阿片类药物的使用可能是造成出生体重较低的原因，尽管没有明确的剂量-反应关系，而生活方式，如不处理产前护理和吸烟量，缩短了怀孕时间。
Two cohorts of substance-using women were compared retrospectively. From 1969 to 1979 a very high perinatal mortality rate (PMR 9.8%) was found among 92 polydrug-using women (1 twin excluded). Preterm delivery occurred in 25% of all pregnancies and in 30% of the children birth weight was below the 10th percentile. Nineteen women using heroin only had a worse fetal outcome (PMR 32%, preterm delivery in 47%, birth weight < 10th percentile in 42%). These results led to a strict surveillance system. In the period 1980-1989, 240 women (4 twins excluded) delivered after 16 weeks. Total fetal loss decreased to 2.1% and PMR to 0.4%, which was similar to results in controls. However, 22% of the women still delivered before 37 weeks and 27% delivered a child < 10th percentile. Methadone-using women were able to halve their dosage during pregnancy and 16 were detoxified. Multivariate analysis within the substance users of the second cohort showed that the neonatal abstinence syndrome, but not the (registered) amount of opiates used, was related to a lower birth weight. Not coping with prenatal care was related to a shorter pregnancy length. Multivariate analysis, including the controls, showed a significant relation of birth weight (345g lower) with substance use. Also, head circumference was 0.8 cm smaller. Length of pregnancy however was related to smoking. This study shows that it is difficult to make substance users attend prenatal care, but also that women coping with prenatal care reduce substance intake. Opiate use might be responsible for lower birth weight, although not in a clear dose-response relationship, whereas lifestyle, as represented by not coping with prenatal care and the quantity of cigarette smoking, shortens the length of pregnancy.