Pathophysiological mechanisms and clinical consequences of exposure of the fetus and newborn to new psychoactive substances — “bath salts”

Abstract

The use of new psychoactive substances (NPS) is increasing every year among various social groups around the world. The use of narcotic drugs during pregnancy, according to various authors, remains at a high level from 2.8% to 7% of pregnant women. The use of new psychoactive substances during pregnancy is characterized by multi-organ damage to the fetus, like other groups of narcotic drugs, however, no organ and tissue specificity for new psychoactive substances has been described. Experimental studies have demonstrated negative pathophysiological mechanisms triggered by synthetic cathinones in the form of increased proapoptotic activity, the formation of autophagolysosomes and reactive oxygen species, and the pro-inflammatory orientation of the immune system. A clinical observation describes a predominant lesion of the nervous system (malformations of the brain, damage to the respiratory center) and the musculoskeletal system (pronounced myotonic syndrome, congenital pathological fractures of the femur), which leads to multiorgan dysfunction, an uncontrolled inflammatory response, and, as a result, to the development of severe disability in such children and growth of the cohort of palliative pediatric patients. In the presented literature review, the authors focus on the pathophysiological mechanisms of action of NPS for a better, deeper and more holistic understanding of the pathological process occurring in the body, in order to form and improve the clinical thinking of medical specialists and cite their own clinical observation as an illustration of the consequences of using new psychoactive substances during pregnancy. The authors believe that this review of the literature with a description of a clinical case is valuable in terms of practical applicability, both for clinicians in various fields and for researchers.