The Royal Women's Hospital, Parkville, Victoria, Australia.
Women Birth. 2011 Mar;24(1):32-9. doi: 10.1016/j.wombi.2010.07.001. Epub 2010 Oct 14.
Substance use in pregnancy is potentially harmful to both the fetus and pregnant woman. At the Royal Women's Hospital, the Women's Alcohol and Drug Service (WADS) provides pregnancy care and counseling for women who have complex drug and/or alcohol issues and psychosocial needs. Women who are stable on pharmacotherapy attend the general pregnancy clinics.
What are the maternal characteristics, pregnancy and neonatal outcomes for a group of women attending for pregnancy care who were on pharmacotherapy substitution treatment, being prescribed buprenorphine or methadone?
All women prescribed buprenorphine or methadone from September 2005 to December 2006 were identified by the hospital pharmacy department where prescribing permits are retained during the woman's pregnancy and postnatal period. Data were collected from medical records and a specific Drug and Alcohol Service database and analysed using descriptive statistics.
Ninety-eight women were identified; 78 were prescribed methadone and 20 buprenorphine. Of these, 76 women also used other substances: tobacco (63%); cannabis (39%); and heroin (37%). Women who received no antenatal care had poorer outcomes overall. Twenty-four percent of live-born infants ≥33 weeks gestation (22/91) required medication for withdrawal. There was no difference in medication requirement where mothers were polysubstance users (18/70; 26%) compared with those who were not (2/21; 19%) (p=0.78), although these small numbers should be viewed with caution. The mean time until medication was required was 3.47 days.
A significant proportion of infants whose mothers used buprenorphine or methadone in pregnancy displayed enough symptoms of withdrawal to require medication. This is therefore an important clinical issue of which care providers need to be aware.
Further prospective research is required to explore whether factors such as specific substances are more likely to be associated with infant withdrawal.
孕期物质使用对胎儿和孕妇都可能有害。在皇家妇女医院，妇女酒精和药物服务（WADS）为有复杂药物和/或酒精问题和心理社会需求的妇女提供妊娠护理和咨询。接受药物替代治疗且病情稳定的妇女会参加一般妊娠诊所。
在接受妊娠护理的妇女中，有一组正在接受美沙酮或丁丙诺啡药物替代治疗的妇女，她们的母体特征、妊娠和新生儿结局是什么？
通过医院药房部门确定 2005 年 9 月至 2006 年 12 月期间开处美沙酮或丁丙诺啡处方的所有妇女，在妇女怀孕期间和产后期间，医院药房保留开处方许可证。从病历和特定的药物和酒精服务数据库中收集数据，并使用描述性统计进行分析。
共确定 98 名妇女；78 名妇女开处美沙酮，20 名妇女开处丁丙诺啡。其中，76 名妇女还使用其他物质：烟草（63%）；大麻（39%）；和海洛因（37%）。未接受产前护理的妇女总体结局较差。≥33 周妊娠（91 名中的 22 名）的活产婴儿中有 24%需要药物戒断治疗。母亲为多药使用者（70 名中的 18 名；26%）与非多药使用者（21 名中的 2 名；19%）相比，需要药物治疗的比例没有差异（p=0.78），尽管这些小数字应谨慎看待。需要药物的平均时间为 3.47 天。
母亲在孕期使用丁丙诺啡或美沙酮的婴儿中，有相当大比例出现了足够多的戒断症状，需要药物治疗。因此，这是一个重要的临床问题，护理提供者需要意识到这一点。
需要进一步进行前瞻性研究，以探讨特定物质等因素是否更有可能与婴儿戒断相关。
