摘要：

Purpose of the study: Maternal substance use during preconception and pregnancy is associated with the increasing risk of adverse perinatal outcomes such as low birth weight, preterm delivery and complications during labour [1]. In recent years, a variety of smoking mixtures under the brand names called "Spice/ K2" also known as "Bonzai/Jamaika" in Turkey, have become increasingly popular among young adults in Europe and United States. These herbal incense products include leafy materials laced with synthetic cannabinoids bound to cannabinoid-like receptors, and they are stronger than natural cannabis [2]. The products are considered as "designer drugs" and sold via internet or in head shops with different brand names like Spice, K2, Aroma since 2004. According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) Report in 2008, the psychoactive effects of "Spice" products were due to added synthetic cannabinoids. JWH-018, an agonist at CB1 and CB2 cannabinoid receptors, are the first reported synthetic cannabinoids in some samples of herbal mixtures [3]. Data regarding prenatal exposure to synthetic cannabinoids are limited to preclinical animal studies, while there are only a few studies on maternal cannabis use and offspring outcomes in humans. This report presents the first human case of synthetic cannabinoid exposure during pregnancy and neonatal outcome. Methods used: A 34-year-old nulliparous woman suffering from bipolar disorder has regularly smoked synthetic cannabinoid "bonzai" twice a week for the last 6 months. When her pregnancy was discovered in the 5th week; she was taking escitalopram (10 mg/day), quetiapine (200 mg/day), venlafaxine (150 mg/day) and lamotrigine (100 mg/day). She did not consume any alcohol and she smoked 10 cigarettes per day. The patient was informed about the risks of drugs. and she decided to give up substance use, but she could not cut it down during pregnancy. Combined antidepressant therapy was discontinued, instead, 100 mg of quetiapine was given to the patient each day as monotherapy. Summary of results: In the 8th, 17th and 28th weeks of her pregnancy, prenatal sonographic examinations revealed normal fetal growth and amniotic fluid volume. Detailed anomaly scan findings were normal and compatible with gestational age. The patient gave birth to a healthy baby at week 38 with normal Apgar scores. The physical and neurological examination of the baby had no abnormalities just after birth and during the 6 month follow-up period. Conclusions: Cannabinoids including natural cannabis have been found to reach the term fetus [4]. Preclinical studies have not shown a consistent pattern of defects with prenatal cannabinoid exposures. Limited information has been also published on exposure to exogenous cannabinoids during human pregnancy. As far as we know, this is the first case report describing prenatal synthetic cannabinoid exposure and birth outcome. Lack of safety information may lead to anxiety in pregnant women and unnecessary pregnancy termination. Therefore, until further reports and studies are published, health professionals should support the patients in making decision and let them know about the chances of having a healthy pregnancy and baby. References [1] Bonello, M.R., Xu, F., Li, Z., Burns, L., Austin, M.P., Sullivan, E.A., 2014. Mental and behavioral disorders due to substance abuse and perinatal outcomes: a study based on linked population data in New South Wales, Australia. Int J Environ Res Public Health 11(5), 4991– 5005. [2] Spaderna, M., Addy, P.H., D'Souza, D.C., 2013. Spicing things up: synthetic cannabinoids. Psychopharmacology 228(4), 525–540. [3] Vardakou, I., Pistos, C., Spiliopoulou, C., 2010. Spice drugs as a new trend: mode of action, identification and legislation. Toxicol Lett 197(3), 157–162. [4] Blackard, C., Tennes, K., 1984. Human placental transfer of cannabinoids. N Engl J Med 311(12), 797.

展开