Etat des lieux de la consommation de substances psychoactives par les femmes enceintes (2010)

FRANÇAIS :
La consommation de substances psychoactives est en augmentation croissante en France et dans le monde. Les évaluations de la consommation de substances sont souvent basées sur des autoquestionnaires et leur interprétation doit demeurer prudente. Les chiffres de prévalence de la consommation de cannabis et/ou de cocaïne chez la femme enceinte sont inconnus en France et sont extrapolés à partir des données recueillies chez la femme en âge de procréer et à partir des données de la littérature internationale. On estime, en France, que 20 à 30 % des femmes consomment du tabac, 15 % au moins de l'alcool, 3 à 10 % du cannabis et 0,5 à 3 % de la cocaïne durant la grossesse. Les conséquences de la consommation de substances psychoactives sont importantes, aussi bien chez la femme enceinte que chez l'enfant. Une meilleure identification du profil des femmes susceptibles de consommer des substances psychoactives pendant leur grossesse permettrait une meilleure prise en charge médicopsychosociale de la mère et de l'enfant et permettrait de mieux cibler les campagnes de prévention et d'information. [Résumé d'auteur]
ENGLISH:
All around the world, the potential consequences of the increasing use of psychoactive substances during pregnancy are a major public health concern. It is estimated that 20 to 30% of pregnant women use tobacco, 15% use alcohol, 3 to 10% use cannabis and 0.5 to 3% use cocaine. The estimation of tobacco consumption during pregnancy is better known as compared with alcohol and substance use prevalence during pregnancy, which remains under estimated or unknown. For example, in France, the prevalence of cannabis and cocaine use during pregnancy is unknown. In general, the prevalence of drug or alcohol use during pregnancy is estimated by extrapolating data from epidemiological studies conducted in the general population (in France or in other countries). However, drug or alcohol use in the general population may dramatically vary from one country to another. Even if some studies have reported the prevalence of alcohol or substance use in different countries around the world, most of them were based on the mother's interview. In most cases, the mother did not report exactly the amount of drugs or alcohol used. Further studies measuring alcohol or substance use in the mother's blood, hair or in the newborn's meconium are needed. In addition, different methodologies have been used in the literature (different types of interview, with or without biological measurements; different subjects included (in- or out-pregnant women, psychiatric comorbidities or not, different economic status, etc). Despite these methodological biases, the prevalence of drug or alcohol use increases in pregnant women, and in most cases, several drugs are associated. Most of the studies have used structured or semi-structured interviews such as the addiction severity index (ASI) or the alcohol use disorders identification test (AUDIT) to assess alcohol or drug consumption. In addition, the identification of risk factors for substance or alcohol use during pregnancy would allow the early detection of these high-risk pregnancies. Environmental factors such as low economic status or marital status may play an important role. Personality disorders may also contribute to substance or alcohol use during pregnancy. In fact, in most studies the quality of the obstetrical survey is lower in pregnant women using drugs or alcohol but it remains difficult to describe a specific at-risk profile in these pregnant women. Consumption of alcohol or of one or more psychoactive substances during pregnancy may have serious consequences on the pregnancy and on the child's development. Fetal alcoholism syndrome is the main etiology of mental retardation in France. We need to improve our knowledge of alcohol and substance use during pregnancy in order to target information for prevention campaigns and to implement specific mother and child medical care in high-risk populations. [Author's abstract]