Fifty Years of Research on Prenatal Substances: Lessons Learned for the Opioid Epidemic.
Fifty Years of Research on Prenatal Substances: Lessons Learned for the Opioid Epidemic.
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DOI：
10.1007/s42844-020-00021-7
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Kable J
中科院分区：
文献类型：
--
作者：
Singer LT;Chambers C;Coles C;Kable J
目前设计产前阿片类药物暴露对发育影响的研究的努力可以受益于50年来对胎儿酒精和产前药物暴露（如可卡因）的研究所获得的知识。神经生物学、发育精神病理学、婴儿评估、遗传学和成像学的科学进展支持指导产前暴露研究的发育神经毒理学原则。对研究设计来说，重要的是准确评估暴露量、频率和时间，这得益于准确的自我报告和暴露生物标志物。识别和控制影响发育的产前和产后因素是困难的，并依赖于适当的研究设计和选择比较组和测量的混杂，中介和调节变量。由于孕妇使用的处方和非处方物质的数量增加，多种物质的暴露增加，不同的药物组合可能对结果产生不同的影响。对婴儿行为的多项实验和临床评估已经开发出来，但在18-24个月之前预测结果仍然很困难。除了一些例外，产前物质暴露的影响大小一直很小，认知和行为的影响往往是具体的，而不是全球性的。研究需要大的样本量，足够的保留，并支持在风险样本的社会服务。伦理和法律的背景和耻辱与药物/酒精使用障碍应考虑，以防止在研究项目中对家庭的伤害。认识到成瘾物质在这个国家的普遍使用应该导致广泛的科学努力，以了解物质如何影响儿童的结果，并在需要时启动预防和干预。
Current efforts to design research on developmental effects of prenatal opioid exposure can benefit from knowledge gained from 50 years of studies of fetal alcohol and prenatal drug exposures such as cocaine. Scientific advances in neurobiology, developmental psychopathology, infant assessments, genetics, and imaging support the principles of developmental neurotoxicology that guide research in prenatal exposures. Important to research design is accurate assessment of amount, frequency, and timing of exposure which benefits from accurate self-report and biomarkers of exposure. Identifying and control of pre- and postnatal factors that impact development are difficult and dependent on appropriate research design and selection of comparison groups and measurement of confounding, mediating, and moderating variables. Polysubstance exposure has increased due to the number of prescribed and nonprescribed substances used by pregnant women and varying combinations of drugs may have differential effects on the outcome. Multiple experimental and clinical assessments of infant behavior have been developed but predicting outcome before 18–24 months of age remains difficult. With some exceptions, prenatal substance exposure effect sizes have been small, and cognitive and behavioral effects tend to be specific rather than global. Studies require large sample sizes, adequate retention, and support for social services in at-risk samples. The ethical and legal contexts and stigma associated with drug/alcohol use disorder should be considered in order to prevent harm to families in research programs. Recognition of the pervasive use of addictive substances in this nation should lead to broad scientific efforts to understand how substances affect child outcomes and to initiate prevention and intervention where needed.
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