Prenatal Drug Exposure: Infant and Toddler Outcomes
Prenatal Drug Exposure: Infant and Toddler Outcomes
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DOI：
10.1080/10550881003684871
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发表时间：
2010-01-01
影响因子：
2.3
通讯作者：
Accornero, Veronica H.
中科院分区：
文献类型：
--
作者：
Bandstra, Emmalee S.;Morrow, Connie E.;Accornero, Veronica H.
这份手稿概述了目前关于孕期母体药物使用，特别是阿片类药物和可卡因对婴儿和幼儿从出生到3岁的急性和长期后果的影响的科学文献。关于阿片类药物，重点放在用于治疗阿片成瘾的海洛因和阿片替代品，包括美沙酮和丁丙诺啡，美沙酮长期以来一直被视为孕期护理的标准，丁丙诺啡正越来越多地作为美沙酮的替代品被调查和开出处方。重点介绍了比较高剂量和低剂量美沙酮的对照研究，以及比较美沙酮和丁丙诺啡的研究，并讨论了新生儿禁欲综合征的诊断和治疗。在过去的二十年里，科学界和非科学界的注意力也集中在可卡因和强效可卡因的潜在不利影响上，特别是在美国可卡因流行的高峰期。在这里，这些发现是从前瞻性研究中总结出来的，这些研究比较了接触可卡因和未接触可卡因的婴幼儿在人体发育、婴儿神经行为、视觉和听觉功能以及认知、运动和语言发育方面的差异。在精心设计的前瞻性研究发现大多数产前暴露的婴儿的后遗症没有最初预期那么严重的证据之前，所谓的crack BabyO的标签可能会带来耻辱的标签。与可能导致新生儿戒断综合症和婴儿神经行为缺陷的阿片类药物相反，产前可卡因暴露似乎与被描述为统计上显著但轻微的神经行为、认知和语言功能下降有关，特别是在其他暴露和可能调解或缓和影响的照料环境的背景下。这些早期的发现是否预示着学龄期和青春期会出现更严重的学习和行为问题，因为孩子不可避免地会面临越来越多的社会和学业挑战，这是正在进行的纵向研究的主题。
This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called ocrack babyo preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.