Gestation

妊娠期
  • 文章类型: Journal Article
    目的:母亲咖啡因穿过胎盘和乳腺屏障,接触到婴儿,因为他/她的咖啡因代谢不成熟,我们的假设是,即使是低咖啡因摄入量(250毫克/天),低于世界卫生组织建议的剂量限制,可以促进后代过度接触咖啡因,导致短期和长期的变化。
    方法:怀孕的Wistar大鼠在妊娠期和哺乳期接受胃内咖啡因(CAF)(25mg/Kg/天)或赋形剂。我们评估了形态计量学,新陈代谢,荷尔蒙,以及不同年龄男女后代的行为参数。
    结果:即使低咖啡因摄入量也会降低母体体重和肥胖,血浆胆固醇升高,血浆T3降低,血浆皮质酮无变化。女性CAF后代表现出较低的出生体重,一生中的体重增长和食物摄入,断奶时的高胰岛素血症,而雄性CAF后代断奶时食物摄入量减少,血浆T3降低。在青春期和成年期,男性CAF对可口食物表现出更高的偏好,厌恶咖啡因摄入量和更高的运动活动,而女性CAF仅表现出对高脂饮食(HFD)的较低偏好和较低的焦虑样行为。成年时,男性和女性后代均显示较高的血浆T3。男性CAF显示高睾酮血症,而女性CAF表现为低胰岛素血症,对糖耐量无影响。
    结论:围产期咖啡因摄入量低影响大鼠子代发育,促进性别依赖的荷尔蒙和行为变化。目前的数据表明,有必要在围产期审查咖啡因的建议。
    OBJECTIVE: Maternal caffeine crosses the placenta and mammary barriers, reaching the baby and, because his/her caffeine metabolism is immature, our hypothesis is that even a low caffeine intake (250 mg/day), lower than the dose limit recommended by the World Health Organization, can promote caffeine overexposure in the offspring, leading to short- and long-term changes.
    METHODS: Pregnant Wistar rats received intragastric caffeine (CAF) (25 mg/Kg/day) or vehicle during the gestation and lactation periods. We evaluated morphometrical, metabolic, hormonal, and behavioral parameters of male and female offspring at different ages.
    RESULTS: Even a low caffeine intake promoted lower maternal body mass and adiposity, higher plasma cholesterol and lower plasma T3, without changes in plasma corticosterone. Female CAF offspring exhibited lower birth weight, body mass gain and food intake throughout life, and hyperinsulinemia at weaning, while male CAF offspring showed reduced food intake and lower plasma T3 at weaning. At puberty and adulthood, male CAF showed higher preference for palatable food, aversion to caffeine intake and higher locomotor activity, while female CAF only showed lower preference for high fat diet (HFD) and lower anxiety-like behavior. At adulthood, both male and female offspring showed higher plasma T3. Male CAF showed hypertestosteronemia, while female CAF showed hypoinsulinemia without effect on glucose tolerance.
    CONCLUSIONS: A low caffeine intake during the perinatal period affects rat\'s offspring development, promoting sex-dependent hormonal and behavior changes. Current data suggest the need to review caffeine recommendations during the perinatal period.
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  • 文章类型: Journal Article
    本文总结了妊娠期甲状腺毒症的诊断和治疗。将概述用于区分妊娠期间甲状腺功能亢进的各种病因与适当的生理变化的诊断临床和生化考虑因素。最后,该审查将讨论怀孕期间甲状腺毒症治疗的现有选择的风险和益处,减轻胎儿甲状腺功能亢进的风险。
    This review summarizes the diagnosis and management of thyrotoxicosis in pregnancy. The diagnostic clinical and biochemical considerations used to distinguish the various etiologies of hyperthyroidism from appropriate physiologic changes during pregnancy will be outlined. Finally, the review will discuss the risks and benefits of available options for the treatment of thyrotoxicosis during pregnancy, to mitigate the risks of fetal hyperthyroidism.
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  • 文章类型: Journal Article
    鉴于宿主-微生物相互作用是由免疫系统反应决定的,重要的是要了解从受孕到生命最初几年期间关键的免疫系统与微生物群的关系。本工作总结了有关人类生殖微生物群的现有证据,而且,生命早期的微生物定植,关注对婴儿发育和健康结果的潜在影响。此外,我们得出的结论是,包括特定益生菌和其他抗生素在内的一些饮食策略可能成为潜在有价值的工具,用于在整个生命周期内实现有针对性的健康结局的早期关键机会窗口期调节母婴微生物群.
    Given that the host-microbe interaction is shaped by the immune system response, it is important to understand the key immune system-microbiota relationship during the period from conception to the first years of life. The present work summarizes the available evidence concerning human reproductive microbiota, and also, the microbial colonization during early life, focusing on the potential impact on infant development and health outcomes. Furthermore, we conclude that some dietary strategies including specific probiotics and other-biotics could become potentially valuable tools to modulate the maternal-neonatal microbiota during this early critical window of opportunity for targeted health outcomes throughout the entire lifespan.
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  • 文章类型: Journal Article
    疾病的治疗和预防改善了人类的寿命。当前关于衰老的研究,如生物钟和抗衰老药物都集中在各种疾病的医学治疗和健康维护上。然而,为了有效地将人类寿命延长到理论上的最大值,医学可以采取进一步的主动方法,并确定影响妊娠的不明显的疾病,身体生长,和所谓的“健康”人口的生殖阶段。目标是通过针对不明显的疾病将标准健康状况提升到一个新的水平。因此,未来的研究可以从反应转变,回应,从预防到积极主动,质量提升和活力延长;从单一疾病导向到健康身体的多维方案;从症状发作的治疗到远离疾病;从健康的老龄化管理到从出生开始的健康推广设计。
    Disease treatment and prevention have improved the human lifespan. Current studies on aging, such as the biological clock and senolytic drugs have focused on the medical treatments of various disorders and health maintenance. However, to efficiently extend the human lifespan to its theoretical maximum, medicine can take a further proactive approach and identify the inapparent disorders that affect the gestation, body growth, and reproductive stages of the so-called \"healthy\" population. The goal is to upgrade the standard health status to a new level by targeting the inapparent disorders. Thus, future research can shift from reaction, response, and prevention to proactive, quality promotion and vigor prolonging; from single disease-oriented to multiple dimension protocol for a healthy body; from treatment of symptom onset to keep away from disorders; and from the healthy aging management to a healthy promotion design beginning at the birth.
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  • 文章类型: Journal Article
    锌是所有物种饮食中所需的必需微量元素。虽然已经在正在生长的小牛中研究了锌的影响,关于锌对妊娠母牛或其新生小牛的微生物群的影响知之甚少。了解影响新生动物肠道健康的因素并评估膳食补充剂在成年妊娠动物中的作用对于促进动物健康和告知喂养实践非常重要。这项研究的目的是确定膳食锌对妊娠牛和小牛的微生物群和抗性的影响。从干燥到产卵,妊娠母牛接受标准(40ppm)或高(205ppm)的饮食锌水平。在登记和产仔时从母牛和新生小牛收集粪便样品。粪便样品进行16SrRNA测序,一个子集也进行了鸟枪宏基因组测序。评估了锌补充对牛和小牛微生物组和抗性组的多样性和组成的影响。随着时间的推移,微生物群的α和β多样性和组成发生了显著变化,但在奶牛中没有经过处理,与新生相比,α多样性降低,并且发现14个属的相对丰度明显更高。27种抗菌素抗性基因的水平随时间显著增加。治疗组和对照组产仔时只有少量分类群差异表达,包括粪杆菌,拟杆菌,Turicibacter,和双歧杆菌。未观察到dam的治疗组对新生儿小牛微生物群的多样性或组成的影响。小牛抗性组,与奶牛相比,它相对丰富多样,也不受大坝治疗组的影响。因此,高水平的膳食锌的影响似乎很小,没有观察到α或β多样性的变化,少数分类群和抗菌素抗性基因的相对丰度变化不大。
    Zinc is an essential trace element required in the diet of all species. While the effects of zinc have been studied in growing calves, little is known about the effect of zinc on the microbiota of the gestating cow or her neonatal calf. Understanding factors that shape the gut health of neonatal animals and evaluating the effect of dietary supplements in adult gestating animals is important in promoting animal health and informing feeding practices. The aims of this study were to determine the effect of dietary zinc on the microbiota and resistome of the gestating cow and calf. Gestating cows received standard (40 ppm) or high (205 ppm) dietary zinc levels from dry off to calving. Fecal samples were collected from cows upon enrollment and at calving and from neonatal calves. Fecal samples underwent 16S rRNA sequencing and a subset also underwent shotgun metagenomic sequencing. The effect of zinc supplementation on the diversity and composition of the cow and calf microbiome and resistome was assessed. Alpha and beta diversity and composition of the microbiota were significantly altered over time but not by treatment in the cows, with alpha diversity decreasing and 14 genera found at significantly higher relative abundances at calving compared to enrollment. Levels of 27 antimicrobial resistance genes significantly increased over time. Only a small number of taxa were differentially expressed at calving in treatment and control groups, including Faecalibacterium, Bacteroides, Turicibacter, and Bifidobacterium pseudolongum. No effect of the dam\'s treatment group was observed on the diversity or composition of the neonatal calf microbiota. The calf resistome, which was relatively rich and diverse compared to the cow, was also unaffected by the dam\'s treatment group. The impact of high levels of dietary zinc thus appeared to be minimal, with no observed changes in alpha or beta diversity, and few changes in the relative abundance of a small number of taxa and antimicrobial resistance genes.
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  • 文章类型: Journal Article
    目的:育龄女性眼科医生面临不同类型的职业风险,这可能对怀孕和胎儿发育有害。本文的目的是分析怀孕期间对这些风险的看法。
    方法:我们设计了一项调查,由42名在怀孕期间工作的眼科医生回答。我们根据代理人的类型报告对全球和特定风险的看法。
    结果:38.1%的眼科医生认为怀孕期间工作的总体风险很高,35.7%认为温和。关于特定风险,最相关的因素是人体工程学和社会心理。物理代理被认为是最不重要的。
    结论:尽管大多数接受调查的眼科医生认为职业风险高或中等,由于这个原因,只有19%的人请假。最重要的因素是人体工程学和社会心理。
    OBJECTIVE: Woman ophthalmologists of childbearing age are exposed to different types of occupational risks which can be harmful to pregnancy and to the development of the fetus. The objective of this paper is to analyze the perception of these risks during pregnancy.
    METHODS: We designed a survey which was answered by 42 ophthalmologists who had been working during pregnancy. We report the perception of global and specific risk according to the type of agent.
    RESULTS: 38.1% of the ophthalmologists perceive that the overall risk of working during pregnancy is high, and 35.7% consider it moderate. Regarding specific risk, the most relevant agents are the ergonomic and psychosocial ones. Physical agents are considered the least important.
    CONCLUSIONS: Although most of the surveyed ophthalmologists perceived the occupational risk as high or moderate, only 19% of them took time off work due to this reason. The most important agents were ergonomic and psychosocial.
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  • 文章类型: Journal Article
    这项研究建立了胎儿大麻素综合征模型,以评估怀孕和哺乳期高剂量屈大麻酚(合成THC)对男性和女性后代行为和大脑变化的影响,以及他们对饮酒的易感性。雌性C57BL/6J小鼠接受屈大麻酚(10mg/kg/12h,p.o.)从妊娠第5天到出生后第21天。在断奶的那一天,后代被性别分开,在出生后第60天,对行为和神经生物学变化进行分析。暴露于屈大麻酚的小鼠表现出增加的焦虑和抑郁样行为以及认知障碍。这些行为与神经发育相关的基因和蛋白表达变化有关。建立,第一次,行为变化之间的联系,认知障碍,和神经生物学改变。怀孕和哺乳期间接触屈大麻酚破坏了奖励系统,导致后代饮酒的动机增加。所有这些修饰都表现出性别依赖性模式。这些发现揭示了怀孕和哺乳期间使用大麻对胎儿神经发育的明显不利影响,并强烈建议有必要防止在此期间使用大麻的母亲对行为和大脑发育可能发生的严重和永久性副作用。
    This study establishes a fetal cannabinoid syndrome model to evaluate the effects of high doses of dronabinol (synthetic THC) during pregnancy and lactation on behavioral and brain changes in male and female progeny and their susceptibility to alcohol consumption. Female C57BL/6J mice received dronabinol (10 mg/kg/12 h, p.o.) from gestational day 5 to postnatal day 21. On the weaning day, the offspring were separated by sex, and on postnatal day 60, behavioral and neurobiological changes were analyzed. Mice exposed to dronabinol exhibited increased anxiogenic and depressive-like behaviors and cognitive impairment. These behaviors were associated with neurodevelopment-related gene and protein expression changes, establishing, for the first time, an association among behavioral changes, cognitive impairment, and neurobiological alterations. Exposure to dronabinol during pregnancy and lactation disrupted the reward system, leading to increased motivation to consume alcohol in the offspring. All these modifications exhibited sex-dependent patterns. These findings reveal the pronounced adverse effects on fetal neurodevelopment resulting from cannabis use during pregnancy and lactation and strongly suggest the need to prevent mothers who use cannabis in this period from the severe and permanent side effects on behavior and brain development that may occur in their children.
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  • 文章类型: Journal Article
    背景:在美国,领先的医学协会建议每天服用81毫克阿司匹林,以预防处于危险中的女性先兆子痫(PE),而英国的NICE指南推荐剂量高达150mg的阿司匹林.最近的数据还表明,在肥胖人群中,剂量不足或阿司匹林抵抗可能会影响目前推荐剂量的阿司匹林疗效.
    目的:我们评估了在高危肥胖孕妇中,每日服用162mg阿司匹林是否比81mg阿司匹林更有效地降低具有严重特征的PE的发生率。
    方法:我们在2019年5月至2022年11月之间进行了一项随机试验。12至20周胎龄(GA)的个体,在招募时BMI≥30kg/m2,和三个高危因素中的至少一个:怀孕前的PE病史,至少在妊娠指数中记录了I期高血压,孕前糖尿病或在20周之前诊断为妊娠糖尿病,随机分为每日162mg或81mg阿司匹林,直至分娩。参与者对治疗分配没有盲化.排除标准为:多胎妊娠,已知的主要胎儿畸形,癫痫症,基线蛋白尿,由于其他适应症,服用阿司匹林,或阿司匹林的禁忌症。主要结局是具有严重特征的PE(PE或具有严重特征的叠加PE,子痫,或帮助)。次要结局包括PE导致的早产率,小于胎龄(SGA),产后出血,早剥,和药物副作用。使用对主要结果的预先计划的贝叶斯分析,需要220的样本量,以中性信息先验估计受益或损害的后验概率。
    结果:在343名符合条件的个人中,220例(64.1%)随机分组。主要结果为209/220(95%)。组间基线特征相似,纳入研究时,162mg阿司匹林组为15.9周,81mg阿司匹林组为15.6周.16周前的登记发生在55/110分配到162mg和58/110分配到81mg阿司匹林。162mg阿司匹林组的主要结局为35%,81mg阿司匹林组的主要结局为40%(后相对风险,0.88;95%可信区间,0.64-1.22)。贝叶斯分析表明,与81mg阿司匹林剂量相比,162mg阿司匹林降低主要结局的概率为78%。由于先兆子痫引起的指示早产率(21%vs21%),SGA(6.5%对2.9%),两组之间的早剥(2.8%vs3.0%)和产后出血(10%vs8.8%)相似。药物不良反应也相似。
    结论:在高危肥胖个体中,有78%的获益概率是162mg阿司匹林与81mg阿司匹林相比可降低具有严重特征的PE的发生率.在该人群中使用162mg阿司匹林与81mg阿司匹林相比,最佳估计减少了12%。此试验支持进行更大的多中心试验。
    BACKGROUND: In the United States, leading medical societies recommend 81 mg of aspirin daily for the prevention of preeclampsia (PE) in women at risk, whereas the NICE guidelines in the UK recommend a dose as high as 150 mg of aspirin. Recent data also suggest that in the obese population, inadequate dosing or aspirin resistance may impact the efficacy of aspirin at the currently recommend doses.
    OBJECTIVE: We evaluated whether daily administration of 162 mg aspirin would be more effective compared to 81 mg in decreasing the rate of PE with severe features in high-risk obese pregnant individuals.
    METHODS: We performed a randomized trial between May 2019 and November 2022. Individuals at 12 to 20-weeks gestational age (GA) with a BMI ≥ 30 kg/m2 at time to enrollment, and at least one of three high risk factors: history of PE in a prior pregnancy, at least stage I hypertension documented in the index pregnancy, pre-gestational diabetes or gestational diabetes diagnosed prior to 20 weeks GA were randomized to either 162 mg or 81 mg of aspirin daily till delivery, participants were not blinded to treatment allocation. Exclusion criteria were: multifetal gestation, known major fetal anomalies, seizure disorder, baseline proteinuria, on aspirin due to other indications, or contraindication to aspirin. The primary outcome was PE with severe features (PE or superimposed PE with severe features, eclampsia, or HELLP). Secondary outcomes included rates of preterm birth due to PE, small for gestational age (SGA), postpartum hemorrhage, abruption, and medication side effects. A sample size of 220 was needed using a preplanned Bayesian analysis of the primary outcome to estimate the posterior probability of benefit or harm with a neutral informative prior.
    RESULTS: Of 343 eligible individuals, 220 (64.1%) were randomized. The primary outcome was available for 209/220 (95%). Baseline characteristics were similar between groups, median gestational age at enrollment was 15.9 weeks in the 162 mg aspirin group and 15.6 weeks in the 81 mg aspirin group. Enrollment prior to 16 weeks occurred in 55/110 of those assigned to 162 mg and 58/110 of those assigned to 81 mg of aspirin. The primary outcome occurred in 35% in the 162 mg aspirin group and in 40% in the 81 mg aspirin group (posterior relative risk, 0.88; 95% credible interval, 0.64-1.22). Bayesian analysis indicated a 78% probability of a reduction in the primary outcome with 162 mg aspirin compared to 81 mg aspirin dose. Rates of indicated preterm birth due to preeclampsia (21% vs 21%), SGA (6.5% vs 2.9%), abruption (2.8% vs 3.0%) and postpartum hemorrhage (10% vs 8.8%) were similar between groups. Medication adverse effects were also similar.
    CONCLUSIONS: Among high-risk obese individuals, there was 78% probability of benefit that 162 mg aspirin compared to 81 mg will decrease the rate of PE with severe features. With a best estimate of a 12% reduction when using 162 mg of aspirin in comparison to 81 mg of aspirin in this population. This trial supports doing a larger multicenter trial.
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  • 文章类型: Journal Article
    产前缺铁和贫血与妊娠期高血压和糖尿病有关,但是铁储备和血红蛋白升高也是如此。在南非,孕妇接受常规补铁,无论铁的状态。
    本研究旨在评估南非城市孕妇产前铁状态和贫血与血压的关系。其次,与心率有关,我们还研究了空腹血糖和糖耐量.
    约翰内斯堡,南非。
    共有250名孕妇,27岁(24-32岁),采用连续抽样招募。作者在<18周和±22周测量了铁状态和贫血的生物标志物,±36周时的血压和心率,妊娠24至28周之间的空腹血糖和糖耐量。使用校正混杂因素的多变量回归模型确定关联。
    妊娠±22周贫血妇女妊娠晚期高血压前期的几率是无贫血妇女的三倍(比值比[OR]:3.01,95%置信区间[CI]:1.22,7.42)。妊娠±22周时贫血的参与者平均动脉压升高的几率是无贫血女性的2.15倍(OR:2.15,95%CI:1.01,4.60)。
    妊娠中期贫血可能是妊娠期高血压疾病的预测因素。除了铁缺乏,产前贫血的原因可能需要进一步调查。生活在南非城市的孕妇贫血的有效管理仍然是一个挑战。
    这项研究提供了有关南非孕妇产前补充措施对健康影响的证据。
    UNASSIGNED: Antenatal iron deficiency and anaemia are associated with gestational hypertension and diabetes mellitus, but so are elevated iron stores and haemoglobin. In South Africa, pregnant women receive routine iron supplementation regardless of iron status.
    UNASSIGNED: This study aimed to assess associations of antenatal iron status and anaemia with blood pressure in pregnant women in urban South Africa. Secondary to this, associations with heart rate, fasting glucose and glucose tolerance were also investigated.
    UNASSIGNED: Johannesburg, South Africa.
    UNASSIGNED: A total of 250 pregnant women, aged 27 (24-32) years, were recruited using consecutive sampling. The authors measured biomarkers of iron status and anaemia at < 18 and ± 22 weeks\', blood pressure and heart rate at ± 36 weeks\', and fasting glucose and glucose tolerance between 24 and 28 weeks\' gestation. Associations were determined using multivariable regression models adjusted for confounders.
    UNASSIGNED: The odds of prehypertension in late pregnancy among women with anaemia at ± 22 weeks\' gestation were three times higher than among women without anaemia (odds ratio [OR]: 3.01, 95% confidence interval [CI]: 1.22, 7.42). Participants with anaemia at ± 22 weeks\' gestation had 2.15 times higher odds of having elevated mean arterial pressure than women without anaemia (OR: 2.15, 95% CI: 1.01, 4.60).
    UNASSIGNED: Anaemia at mid-pregnancy could be a predictor of hypertensive disorders in pregnancy. The cause of antenatal anaemia may need further investigation apart from iron deficiency. The effective management of anaemia in pregnant women living in urban South Africa remains a challenge.
    UNASSIGNED: This study provides evidence about the health impact of pregnant women regarding antenatal supplementation practices in South Africa.
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  • 文章类型: Journal Article
    在美国,孕妇中阿片类药物相关问题的发生率不断上升,这突显了了解怀孕期间阿片类药物使用和阿片类药物使用障碍(MOUD)的影响的关键必要性。这项研究采用了一种翻译啮齿动物模型来研究妊娠暴露于丁丙诺啡(BUP)或吗啡对母体行为和后代幸福感的影响。雌性大鼠在受孕前接受BUP或吗啡,代表既定用途,暴露持续到出生后第2天或在妊娠第19天停止,以模拟出生前停止治疗。产妇的行为-包括护理,幼犬检索,和偏好-以及狩猎行为和脑神经递质水平进行了评估。评估后代的死亡率,体重,长度,牛奶带,表面扶正延迟,戒断症状,和大脑神经递质水平。我们的结果表明,无论暴露时间长短(即,继续或终止),与吗啡暴露和对照大坝相比,BUP导致产妇护理减少。阿片类药物暴露改变了水坝和后代的大脑单胺水平,并与新生儿死亡率增加有关,减少后代的体重,与对照组相比,戒断症状升高。这些发现强调了BUP对产妇保健的潜在干扰,有助于增加幼崽的死亡率和改变后代的神经发育结果。这项研究要求对产前BUP暴露对母体大脑和婴儿发育的影响进行更全面的研究,以减轻怀孕期间暴露于阿片类药物的人类的不良后果。
    The escalating incidence of opioid-related issues among pregnant women in the United States underscores the critical necessity to understand the effects of opioid use and Medication for Opioid Use Disorders (MOUDs) during pregnancy. This research employed a translational rodent model to examine the impact of gestational exposure to buprenorphine (BUP) or morphine on maternal behaviors and offspring well-being. Female rats received BUP or morphine before conception, representing established use, with exposure continuing until postnatal day 2 or discontinued on gestational day 19 to mimic treatment cessation before birth. Maternal behaviors - including care, pup retrieval, and preference - as well as hunting behaviors and brain neurotransmitter levels were assessed. Offspring were evaluated for mortality, weight, length, milk bands, surface righting latency, withdrawal symptoms, and brain neurotransmitter levels. Our results reveal that regardless of exposure length (i.e., continued or discontinued), BUP resulted in reduced maternal care in contrast to morphine-exposed and control dams. Opioid exposure altered brain monoamine levels in the dams and offspring, and was associated with increased neonatal mortality, reduced offspring weight, and elevated withdrawal symptoms compared to controls. These findings underscore BUP\'s potential disruption of maternal care, contributing to increased pup mortality and altered neurodevelopmental outcomes in the offspring. This study calls for more comprehensive research into prenatal BUP exposure effects on the maternal brain and infant development with the aim to mitigate adverse outcomes in humans exposed to opioids during pregnancy.
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