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Sus efectos vasoconstrictores contribuyen a la disfunci&#243;n placentaria&#44; y su f&#225;cil difusi&#243;n a trav&#233;s de la barrera hemato-placentaria puede tener efectos significantes en el feto<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;5</span></a>&#46; Sin embargo&#44; no se han comunicado casos con malformaciones&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Describimos 9 casos de hijos de madres consumidoras de <span class="elsevierStyleItalic">&#171;shab&#250;&#187;</span>&#44; observados en nuestra unidad neonatal desde junio de 2013 a marzo de 2016 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Nuestros casos presentan factores de riesgo en com&#250;n&#58; origen filipino&#44; gestaciones con escaso o ning&#250;n control&#44; e importantes problemas sociales &#40;algunos de los casos ten&#237;an historia social previa&#41;&#46; En 5 casos se ha podido demostrar un consumo cr&#243;nico durante toda la gestaci&#243;n mediante la detecci&#243;n de MA en el cabello de la madre&#44; y en ning&#250;n caso hubo asociaci&#243;n de otras sustancias de abuso&#44; posiblemente porque el patr&#243;n de consumo&#44; en estas mujeres&#44; no es recreativo sino para aguantar largas jornadas de trabajo&#46; Los resultados perinatales se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Queremos destacar el &#250;ltimo caso&#44; afecto de una grave malformaci&#243;n cerebral &#40;ventriculomegalia bilateral con efecto masa en fosa posterior&#44; malformaci&#243;n del desarrollo cortical derecho&#44; adelgazamiento cortical izquierdo y posible ausencia de cuerpo calloso&#41; que ha precisado tratamiento neuroquir&#250;rgico&#46; El consumo de MA podr&#237;a explicarlo dado que cualquier da&#241;o en el primer trimestre&#44; por ejemplo de causa vascular&#44; puede ocasionar malformaciones graves en el desarrollo cortical&#59; aunque por carecer de ecograf&#237;as prenatales&#44; no podemos datar el momento de aparici&#243;n de la lesi&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nos llama la atenci&#243;n que&#44; pese al poder adictivo de MA&#44; ninguno ha presentado manifestaciones neuro-conductuales ni letargia los primeros d&#237;as de vida&#44; incluso en los que se ha demostrado una exposici&#243;n a MA durante toda la gestaci&#243;n&#46; El consumo de <span class="elsevierStyleItalic">&#171;shab&#250;&#187;</span> ha permitido detectar problemas sociales subyacentes&#44; de tal gravedad&#44; que han derivado en la retirada de la custodia en todos los casos menos uno que permanece en seguimiento domiciliario por servicios sociales&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La MA es una de las drogas de abuso m&#225;s adictivas&#44; asoci&#225;ndose con m&#250;ltiples adversidades psicosociales y econ&#243;micas que dificultan un ambiente adecuado para la crianza y cuidado de un reci&#233;n nacido<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;6</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El consumo de MA durante el embarazo se asocia con nivel socioecon&#243;mico bajo&#44; riesgo aumentado de problemas legales&#44; mayor prevalencia de hogar monoparental y percepciones maternas de baja calidad de vida&#46; Suele coexistir un entorno social y familiar consumidor de sustancias de abuso<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;6</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Las mujeres consumidoras de MA durante el embarazo presentan mayor consumo de otras sustancias teratog&#233;nicas que hay que tener en cuenta&#44; como alcohol&#44; tabaco y marihuana<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;4&#8211;6</span></a>&#46; Se ha observado mayor comorbilidad de enfermedad psiqui&#225;trica&#58; depresi&#243;n&#44; ideas paranoicas&#44; insomnio y agresividad<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4&#44;6</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El principal problema asociado al consumo de MA durante el embarazo es el control prenatal inadecuado o inexistente&#44; lo que dificulta el v&#237;nculo a servicios sociales y salud mental<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La baja asistencia al servicio sanitario se observa tambi&#233;n en la &#233;poca posnatal&#44; y conduce a situaciones de negligencia y abuso infantil en estos hogares&#44; con aumento de la p&#233;rdida de custodia durante la infancia<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Reportamos el primer estudio en Espa&#241;a de exposici&#243;n prenatal a MA en la comunidad filipina&#44; que incluye un caso con una malformaci&#243;n del SNC y&#44; en todos ellos&#44; graves problemas sociales no detectados anteriormente&#44; por carecer de controles prenatales&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Con esta publicaci&#243;n queremos dar una voz de alarma que permita detectar a estas poblaciones de riesgo con el fin de conseguir un seguimiento prenatal multidisciplinar que integre al equipo obst&#233;trico&#44; servicios de soporte psiqui&#225;trico y social&#46; De esta forma&#44; se podr&#237;a intentar hacer un trabajo con estas gestantes para reconducir su adicci&#243;n&#44; evitar efectos delet&#233;reos en los reci&#233;n nacidos y trabajar el v&#237;nculo familiar&#46;</p></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nacionalidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Filipina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Control gestaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Escaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Escaso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Historia social&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Edad gestacional &#40;semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peso &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;205 &#40;P<span class="elsevierStyleInf">4</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;835 &#40;P<span class="elsevierStyleInf">95</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;135 &#40;P<span class="elsevierStyleInf">65</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;055 &#40;P<span class="elsevierStyleInf">63</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;560 &#40;P<span class="elsevierStyleInf">17</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;864 &#40;P<span class="elsevierStyleInf">95</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;160 &#40;P<span class="elsevierStyleInf">41</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;860 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>P<span class="elsevierStyleInf">1</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;318 &#40;P<span class="elsevierStyleInf">45</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Talla &#40;cm&#41;<br>Percentil &#40;P&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45<br>&#40;P<span class="elsevierStyleInf">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<br>&#40;P<span class="elsevierStyleInf">20</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<br>&#40;P<span class="elsevierStyleInf">35</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49<br>&#40;P<span class="elsevierStyleInf">60</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46<br>&#40;P<span class="elsevierStyleInf">7</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<br>&#40;P<span class="elsevierStyleInf">91</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49<br>&#40;P<span class="elsevierStyleInf">31</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>P<span class="elsevierStyleInf">1</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;5<br>&#40;P<span class="elsevierStyleInf">67</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Per&#237;metro craneal &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;P<span class="elsevierStyleInf">38</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34<br>&#40;P<span class="elsevierStyleInf">44</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33<br>&#40;P<span class="elsevierStyleInf">38</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32<br>&#40;P<span class="elsevierStyleInf">20</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32<br>&#40;P<span class="elsevierStyleInf">17</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33<br>&#40;P<span class="elsevierStyleInf">79</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;5<br>&#40;P<span class="elsevierStyleInf">53</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;5<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>P<span class="elsevierStyleInf">1</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;5<br>&#40;P<span class="elsevierStyleInf">81</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MA orina madre&#47;RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MA cabello madre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
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Exposición prenatal a metanfetamina «shabú»
Prenatal exposure to metamphetamine «shabu»
Cristina Manzano Varo, M. Ángeles López-Vílchez
Autor para correspondencia
93488@parcdesalutmar.cat

Autor para correspondencia.
, Lucía Román Eyo, Jordi García García, Antonio Mur Sierra
Sección de Neonatología, Servicio de Pediatría, Hospital del Mar, Barcelona, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os se ha detectado en nuestro pa&#237;s el consumo de clorhidrato de metanfetamina &#40;MA&#41; o metanfetamina cristalizada&#44; conocido como <span class="elsevierStyleItalic">&#171;shab&#250;&#187;</span>&#44; y asociado principalmente a la comunidad filipina&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La fabricaci&#243;n de estimulantes ha crecido considerablemente&#44; y su consumo es actualmente un grave problema a nivel mundial<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#8211;4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La principal v&#237;a de consumo es fumado&#44; actuando a nivel del sistema nervioso central &#40;SNC&#41; mediante la liberaci&#243;n de aminas e inhibici&#243;n de recaptaci&#243;n de catecolaminas&#44; provocando sus efectos deseados principales&#58; incremento de energ&#237;a y del estado de alerta&#44; efecto de euforia y disminuci&#243;n del apetito<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La exposici&#243;n fetal a MA se asocia con alteraciones f&#237;sicas como prematuridad&#44; bajo peso y baja talla&#44; y diminuci&#243;n del per&#237;metro craneal &#40;PC&#41;&#44; neuro-conductuales &#40;irritabilidad&#44; hiperton&#237;a y&#44; en algunos casos&#44; letargia&#41; y secuelas a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;5</span></a>&#46; Se necesitan m&#225;s estudios para ampliar estos resultados&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El consumo de MA durante el embarazo es un problema alarmante en los pa&#237;ses desarrollados<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Sus efectos vasoconstrictores contribuyen a la disfunci&#243;n placentaria&#44; y su f&#225;cil difusi&#243;n a trav&#233;s de la barrera hemato-placentaria puede tener efectos significantes en el feto<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;5</span></a>&#46; Sin embargo&#44; no se han comunicado casos con malformaciones&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Describimos 9 casos de hijos de madres consumidoras de <span class="elsevierStyleItalic">&#171;shab&#250;&#187;</span>&#44; observados en nuestra unidad neonatal desde junio de 2013 a marzo de 2016 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Nuestros casos presentan factores de riesgo en com&#250;n&#58; origen filipino&#44; gestaciones con escaso o ning&#250;n control&#44; e importantes problemas sociales &#40;algunos de los casos ten&#237;an historia social previa&#41;&#46; En 5 casos se ha podido demostrar un consumo cr&#243;nico durante toda la gestaci&#243;n mediante la detecci&#243;n de MA en el cabello de la madre&#44; y en ning&#250;n caso hubo asociaci&#243;n de otras sustancias de abuso&#44; posiblemente porque el patr&#243;n de consumo&#44; en estas mujeres&#44; no es recreativo sino para aguantar largas jornadas de trabajo&#46; Los resultados perinatales se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Queremos destacar el &#250;ltimo caso&#44; afecto de una grave malformaci&#243;n cerebral &#40;ventriculomegalia bilateral con efecto masa en fosa posterior&#44; malformaci&#243;n del desarrollo cortical derecho&#44; adelgazamiento cortical izquierdo y posible ausencia de cuerpo calloso&#41; que ha precisado tratamiento neuroquir&#250;rgico&#46; El consumo de MA podr&#237;a explicarlo dado que cualquier da&#241;o en el primer trimestre&#44; por ejemplo de causa vascular&#44; puede ocasionar malformaciones graves en el desarrollo cortical&#59; aunque por carecer de ecograf&#237;as prenatales&#44; no podemos datar el momento de aparici&#243;n de la lesi&#243;n&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nos llama la atenci&#243;n que&#44; pese al poder adictivo de MA&#44; ninguno ha presentado manifestaciones neuro-conductuales ni letargia los primeros d&#237;as de vida&#44; incluso en los que se ha demostrado una exposici&#243;n a MA durante toda la gestaci&#243;n&#46; El consumo de <span class="elsevierStyleItalic">&#171;shab&#250;&#187;</span> ha permitido detectar problemas sociales subyacentes&#44; de tal gravedad&#44; que han derivado en la retirada de la custodia en todos los casos menos uno que permanece en seguimiento domiciliario por servicios sociales&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La MA es una de las drogas de abuso m&#225;s adictivas&#44; asoci&#225;ndose con m&#250;ltiples adversidades psicosociales y econ&#243;micas que dificultan un ambiente adecuado para la crianza y cuidado de un reci&#233;n nacido<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;6</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El consumo de MA durante el embarazo se asocia con nivel socioecon&#243;mico bajo&#44; riesgo aumentado de problemas legales&#44; mayor prevalencia de hogar monoparental y percepciones maternas de baja calidad de vida&#46; Suele coexistir un entorno social y familiar consumidor de sustancias de abuso<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4&#44;6</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Las mujeres consumidoras de MA durante el embarazo presentan mayor consumo de otras sustancias teratog&#233;nicas que hay que tener en cuenta&#44; como alcohol&#44; tabaco y marihuana<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;4&#8211;6</span></a>&#46; Se ha observado mayor comorbilidad de enfermedad psiqui&#225;trica&#58; depresi&#243;n&#44; ideas paranoicas&#44; insomnio y agresividad<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">3&#44;4&#44;6</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El principal problema asociado al consumo de MA durante el embarazo es el control prenatal inadecuado o inexistente&#44; lo que dificulta el v&#237;nculo a servicios sociales y salud mental<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;4</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La baja asistencia al servicio sanitario se observa tambi&#233;n en la &#233;poca posnatal&#44; y conduce a situaciones de negligencia y abuso infantil en estos hogares&#44; con aumento de la p&#233;rdida de custodia durante la infancia<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Reportamos el primer estudio en Espa&#241;a de exposici&#243;n prenatal a MA en la comunidad filipina&#44; que incluye un caso con una malformaci&#243;n del SNC y&#44; en todos ellos&#44; graves problemas sociales no detectados anteriormente&#44; por carecer de controles prenatales&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Con esta publicaci&#243;n queremos dar una voz de alarma que permita detectar a estas poblaciones de riesgo con el fin de conseguir un seguimiento prenatal multidisciplinar que integre al equipo obst&#233;trico&#44; servicios de soporte psiqui&#225;trico y social&#46; De esta forma&#44; se podr&#237;a intentar hacer un trabajo con estas gestantes para reconducir su adicci&#243;n&#44; evitar efectos delet&#233;reos en los reci&#233;n nacidos y trabajar el v&#237;nculo familiar&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Edad gestacional &#40;semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peso &#40;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;205 &#40;P<span class="elsevierStyleInf">4</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;835 &#40;P<span class="elsevierStyleInf">95</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;135 &#40;P<span class="elsevierStyleInf">65</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;055 &#40;P<span class="elsevierStyleInf">63</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;560 &#40;P<span class="elsevierStyleInf">17</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;864 &#40;P<span class="elsevierStyleInf">95</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;160 &#40;P<span class="elsevierStyleInf">41</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;860 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>P<span class="elsevierStyleInf">1</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;318 &#40;P<span class="elsevierStyleInf">45</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Talla &#40;cm&#41;<br>Percentil &#40;P&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45<br>&#40;P<span class="elsevierStyleInf">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<br>&#40;P<span class="elsevierStyleInf">20</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<br>&#40;P<span class="elsevierStyleInf">35</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49<br>&#40;P<span class="elsevierStyleInf">60</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46<br>&#40;P<span class="elsevierStyleInf">7</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<br>&#40;P<span class="elsevierStyleInf">91</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49<br>&#40;P<span class="elsevierStyleInf">31</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>P<span class="elsevierStyleInf">1</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#44;5<br>&#40;P<span class="elsevierStyleInf">67</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Per&#237;metro craneal &#40;cm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;P<span class="elsevierStyleInf">38</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34<br>&#40;P<span class="elsevierStyleInf">44</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33<br>&#40;P<span class="elsevierStyleInf">38</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32<br>&#40;P<span class="elsevierStyleInf">20</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32<br>&#40;P<span class="elsevierStyleInf">17</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33<br>&#40;P<span class="elsevierStyleInf">79</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;5<br>&#40;P<span class="elsevierStyleInf">53</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#44;5<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>P<span class="elsevierStyleInf">1</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;5<br>&#40;P<span class="elsevierStyleInf">81</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MA orina madre&#47;RN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#63;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#47;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MA cabello madre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alteraciones neonatales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aspiraci&#243;n meconial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mioclonias benignas del sue&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Malformaci&#243;n cerebral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retirada custodia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Resumen de los casos</p>"
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                    0 => array:2 [
                      "titulo" => "Examining the relationships between prenatal methamphetamine exposure&#44; early adversity&#44; and child neurobehavioral disinhibition"
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                            5 => "C&#46; Neal"
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                    0 => array:2 [
                      "doi" => "10.1037/a0030157"
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                      "titulo" => "Predictors of inadequate prenatal care in methamphetamine-using mothers in New Zealand and United States"
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                            5 => "C&#46; Derauf"
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                    0 => array:2 [
                      "doi" => "10.1007/s10995-012-1033-8"
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                        "tituloSerie" => "Matern Child Health J"
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                      "titulo" => "The methamphetamine problem in the United States"
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                    0 => array:2 [
                      "doi" => "10.1146/annurev.publhealth.012809.103600"
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                        "volumen" => "31"
                        "paginaInicial" => "385"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20070191"
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                          "autores" => array:6 [
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                            4 => "R&#46; Shah"
                            5 => "L&#46; Smith"
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                    0 => array:2 [
                      "doi" => "10.1016/j.drugalcdep.2012.06.016"
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                            4 => "J&#46; Kuo"
                            5 => "C&#46; Berkowitz"
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Información del artículo
ISSN: 16954033
Idioma original: Español
DOI:10.1016/j.anpedi.2016.05.010
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