Berghella Vincenzo, Lim Pearl J, Hill Mary K, Cherpes Jennifer, Chennat Jennifer, Kaltenbach Karol
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
Am J Obstet Gynecol. 2003 Aug;189(2):312-7. doi: 10.1067/s0002-9378(03)00520-9.
The purpose of this study was to determine whether maternal methadone dosage correlates with neonatal withdrawal in a large heroin-addicted pregnant population.
A retrospective review of all maternal/neonatal records of pregnancies that were maintained on methadone therapy in our institution was conducted. After in-hospital stabilization, women were given daily methadone therapy under direct surveillance, with liberal dosage increases according to maternal withdrawal symptoms. Neonatal withdrawal was assessed objectively by the neonatal abstinence score. The average methadone dose in the last 12 weeks of pregnancy and the last methadone dose before delivery (cutoffs of 40, 60, or 80 mg) were correlated to various objective measures of neonatal withdrawal.
One hundred mother/neonate pairs on methadone therapy were identified. Women who received an average methadone dose of <80 mg (n=50 women) had a trend toward a higher incidence of illicit drug abuse before delivery than women who received doses of >/=80 mg (n=50 women; 48% vs 32%; P=.1). Women who received an average methadone dose of <80 mg had similar highest neonatal abstinence score, need for neonatal treatment for withdrawal, and duration of withdrawal compared with women whose condition was maintained with dosages of >/=80 mg (score, 11.1 vs 11.5; 68% vs 66%; and 13.3 vs 13.6 days, respectively; all P>.5). For all cutoffs that were used for high versus low dose and for both the average and last methadone dosage analyses, neonatal withdrawal was similar.
The maternal methadone dosage does not correlate with neonatal withdrawal; therefore, maternal benefits of effective methadone dosing are not offset by neonatal harm.
本研究旨在确定在大量海洛因成瘾的孕妇群体中，母亲美沙酮剂量与新生儿戒断反应之间是否存在关联。
对本院接受美沙酮治疗的所有孕产妇/新生儿记录进行回顾性分析。在住院病情稳定后，女性患者在直接监测下接受每日美沙酮治疗，并根据母亲的戒断症状酌情增加剂量。通过新生儿戒断评分对新生儿戒断反应进行客观评估。将妊娠最后12周的平均美沙酮剂量以及分娩前的最后一剂美沙酮剂量（临界值为40、60或80毫克）与新生儿戒断反应的各项客观指标进行关联分析。
共确定了100对接受美沙酮治疗的母婴。平均美沙酮剂量<80毫克的女性（n = 50）在分娩前非法药物滥用的发生率高于平均美沙酮剂量≥80毫克的女性（n = 50；48%对32%；P = 0.1）。平均美沙酮剂量<80毫克的女性与平均美沙酮剂量≥80毫克的女性相比，其新生儿戒断评分最高值、因戒断接受新生儿治疗的需求以及戒断持续时间相似（评分分别为11.1对11.5；68%对66%；13.3天对13.6天；所有P>0.5）。对于用于区分高剂量与低剂量的所有临界值以及平均和最后美沙酮剂量分析，新生儿戒断反应均相似。
母亲美沙酮剂量与新生儿戒断反应无关；因此，有效剂量美沙酮对母亲的益处不会因对新生儿的伤害而抵消。
