Prenatal care reduces the impact of illicit drug use on perinatal outcomes.
Prenatal care reduces the impact of illicit drug use on perinatal outcomes.
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DOI：
10.1038/sj.jp.7210933
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发表时间：
2003-07-01
期刊：
影响因子：
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通讯作者：
Grylack, Lawrence
中科院分区：
文献类型：
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作者：
El-Mohandes, Ayman;Herman, Allen A;Grylack, Lawrence
目的：评估孕期接触非法药物(IDU)的婴儿中，产前护理(PNC)对早产、低出生体重(LBW)和小于胎龄(SGA)状态的保护作用。研究设计：这是一项前瞻性队列分析，包括哥伦比亚特区(美国华盛顿特区)四家城市医院的6673名女性居民。妇女在产后立即进行筛查。PNC水平根据美国妇产科学会指南和Kotelchuck指数建立。比较不同亚组间的PNC和IDU。根据IDU和PNC水平在不同组中计算调整后的早产儿、LBW和SGA的相对危险度，控制母体和胎龄。结果：在筛查的母亲中，IDU的确诊率为13%。PNC分为无(6%)、不足(10%)、中等(20%)和可(%)。早产、LBW或SGA的风险最高的是孕期无PNC且IDU阳性的母亲所生的婴儿(早产OR=12.05，95%CI：8.99~16.16；LBW OR=14.76，95%CI：11.03~19.75；SGA OR=9.20，95%CI：5.32~15.92)。随着PNC水平的增加，暴露于IDU的婴儿中早产和LBW(不包括SGA)的风险显著降低。当引入PNC时，暴露于IDU的婴儿发生SGA的风险显著降低。结论：在暴露于IDU的婴儿中，随着PNC水平的提高，早产儿、LBW和SGA的风险一直在降低。在高危人群中，卫生保健应寻求及早接触母亲，特别是那些被确定为有注射吸毒者风险的母亲，并有效地向她们提供PNC。
OBJECTIVE: To estimate the extent that prenatal care (PNC) retains its protective influence against prematurity, low birth weight (LBW), and small for gestational age (SGA) status in infants exposed to illicit drug use (IDU) in pregnancy.STUDY DESIGN: This was a prospective cohort analysis including 6673 women residents of the District of Columbia (Washington, DC, USA) delivering at four city hospitals. Women were screened in the immediate postpartum period. Levels of PNC were established according to American College of Obstetrics and Gynecology guidelines and the Kotelchuck index. PNC and IDU were compared between subgroups. Adjusted relative risks for prematurity, LBW and SGA, controlling for maternal and gestational ages, were calculated in different groups according to IDU and level of PNC.RESULTS: IDU was identified in 13% of mothers screened. PNC was classified as none (6%), inadequate (10%), intermediate (20%), and adequate (64%). The highest risk for prematurity, LBW, or SGA occurred in infants born to mothers with no PNC and positive IDU in pregnancy (prematurity OR=12.05, 95% CI: 8.99 to 16.16; LBW OR=14.76, 95% CI: 11.03 to 19.75; SGA OR=9.20, 95% CI: 5.32 to 15.92). As PNC levels increased, significant reductions in risk for prematurity and LBW (not for SGA) in IDU-exposed infants were observed. Risk for SGA in IDU-exposed infants reduced significantly when PNC was introduced.CONCLUSIONS: In infants exposed to IDU, a reduction in risk for prematurity, LBW, and SGA, was consistently demonstrated with improved levels of PNC. In high-risk populations, health care should seek to reach mothers early, especially those identified at risk for IDU, and deliver PNC to them effectively.