Int J Gynaecol Obstet. 2011 Aug;114(2):190-202. doi: 10.1016/j.ijgo.2011.06.001.
To improve awareness and knowledge of problematic substance use in pregnancy and to provide evidence-based recommendations for the management of this challenging clinical issue for all health care providers.
This guideline reviews the use of screening tools, general approach to care, and recommendations for clinical management of problematic substance use in pregnancy.
Evidence-based recommendations for screening and management of problematic substance use during pregnancy and lactation.
Medline, PubMed, CINAHL, and The Cochrane Library were searched for articles published from 1950 using the following key words: substance-related disorders, mass screening, pregnancy complications, pregnancy, prenatal care, cocaine, cannabis, methadone, opioid, tobacco, nicotine, solvents, hallucinogens, and amphetamines. Results were initially restricted to systematic reviews and randomized control trials/controlled clinical trials. A subsequent search for observational studies was also conducted because there are few RCTs in this field of study. Articles were restricted to human studies published in English. Additional articles were located by hand searching through article reference lists. Searches were updated on a regular basis and incorporated in the guideline up to December 2009. Grey (unpublished) literature was also identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1).
BENEFITS, HARMS, AND COSTS: This guideline is intended to increase the knowledge and comfort level of health care providers caring for pregnant women who have substance use disorders. Improved access to health care and assistance with appropriate addiction care leads to reduced health care costs and decreased maternal and neonatal morbidity and mortality.
提高对妊娠期间问题物质使用的认识和了解，并为所有医疗保健提供者提供管理这一具有挑战性的临床问题的循证建议。
本指南审查了筛查工具的使用、一般护理方法，以及妊娠期间问题物质使用的临床管理建议。
妊娠和哺乳期问题物质使用的筛查和管理的循证建议。
使用以下关键词在 1950 年以来的 Medline、PubMed、CINAHL 和 The Cochrane Library 中搜索文章：物质相关障碍、大规模筛查、妊娠并发症、妊娠、产前保健、可卡因、大麻、美沙酮、阿片类药物、烟草、尼古丁、溶剂、致幻剂和安非他命。结果最初仅限于系统评价和随机对照试验/对照临床试验。由于该研究领域的 RCT 较少，因此还进行了随后对观察性研究的搜索。文章仅限于以英语发表的人类研究。通过手动搜索文章参考文献列表还找到了其他文章。定期更新搜索结果，并将其纳入指南，直至 2009 年 12 月。还通过搜索卫生技术评估和卫生技术评估相关机构、临床实践指南集、临床试验登记处以及国家和国际医学专业协会的网站，确定了未发表的灰色文献。
使用加拿大预防保健卫生技术评估报告中描述的标准来评估证据质量。根据该报告中描述的方法（表 1）对实践建议进行排名。
益处、危害和成本：本指南旨在提高照顾有物质使用障碍的孕妇的医疗保健提供者的知识和舒适度。增加获得医疗保健的机会，并提供适当的成瘾护理，可降低医疗保健成本，并降低母婴发病率和死亡率。
