Kahila Hanna, Saisto Terhi, Kivitie-Kallio Satu, Haukkamaa Maija, Halmesmäki Erja
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Acta Obstet Gynecol Scand. 2007;86(2):185-90. doi: 10.1080/00016340601110770.
Exposure to illicit drugs in utero is associated with low birth weight and premature birth. Therefore, maintenance therapy for opioid dependence during pregnancy has been recommended to help withdrawal from street drugs, in order to improve maternal health and decrease risks to the fetus.
In 2002-2005, 67 pregnancies of 66 buprenorphine users were followed prospectively in an outpatient multidisciplinary antenatal setting by an obstetrician, a midwife, a psychiatric nurse and a social worker. Decreasing doses or even abstinence from buprenorphine was encouraged. Outcome measures were daily buprenorphine dose, fetal growth, gestational age at birth, mode of delivery, birth weight, Apgar scores, umbilical pH values, and occurrence of neonatal abstinence syndrome [NAS]. National statistics were used as reference values.
The daily dose of buprenorphine decreased by 2.3 mg (median, range increase of 8 mg to decrease of 24 mg). There were no more incidences of premature birth, cesarean section, low Apgar scores (< or = 6) or umbilical artery pH <7.05 at birth than in the national register, despite the lower birth weight. A total of 91% of the infants needed treatment in a neonatal care unit, 76% had NAS, and 57% needed morphine replacement therapy. Seven infants were taken into care directly from the maternity hospital. Two sudden infant deaths occurred later.
The pregnancies and deliveries of buprenorphine-using women were uneventful, but severe NAS and need for morphine replacement therapy was seen in 57% of the buprenorphine-exposed newborns. A high number of sudden infant deaths occurred.
子宫内接触非法药物与低出生体重和早产有关。因此，建议在孕期对阿片类药物依赖进行维持治疗，以帮助戒除街头毒品，从而改善母亲健康状况并降低对胎儿的风险。
2002年至2005年期间，一名产科医生、一名助产士、一名精神科护士和一名社会工作者在门诊多学科产前环境中对66名使用丁丙诺啡的孕妇的67次妊娠进行了前瞻性跟踪。鼓励减少丁丙诺啡剂量甚至完全戒除。观察指标包括每日丁丙诺啡剂量、胎儿生长情况、出生时的孕周、分娩方式、出生体重、阿氏评分、脐动脉pH值以及新生儿戒断综合征（NAS）的发生情况。使用国家统计数据作为参考值。
丁丙诺啡的每日剂量减少了2.3毫克（中位数，范围从增加8毫克到减少24毫克）。尽管出生体重较低，但早产、剖宫产、低阿氏评分（≤6分）或出生时脐动脉pH值<7.05的发生率与国家登记数据相比并无增加。共有91%的婴儿需要在新生儿重症监护病房接受治疗，76%的婴儿出现NAS，57%的婴儿需要吗啡替代治疗。七名婴儿直接从妇产医院被送入福利院。后来发生了两例婴儿猝死。
使用丁丙诺啡的女性的妊娠和分娩过程较为顺利，但在57%暴露于丁丙诺啡的新生儿中出现了严重的NAS且需要吗啡替代治疗。发生了大量婴儿猝死事件。
