Chisolm Margaret S, Acquavita Shauna P, Kaltenbach Karol, Winklbaur Bernadette, Heil Sarah H, Martin Peter R, Stine Susan M, Coyle Mara, Leoutsakos Jeannie-Marie S, Tuten Michelle, Jansson Lauren M, Backer Penina M, Jones Hendrée E
Johns Hopkins University, Baltimore, MD, USA.
Addict Disord Their Treat. 2011 Dec;10(4):180-187. doi: 10.1097/ADT.0b013e31821cadbd.
To investigate whether cigarette smoking and/or depression contribute to neonatal abstinence syndrome (NAS) severity. DESIGN: Cohort study analyzing data from a randomized, controlled trial of methadone versus buprenorphine. SETTING: Seven study sites that randomized patients to study conditions and provided comprehensive addiction treatment to pregnant patients. PARTICIPANTS: 119 of 131 opioid-dependent pregnant patients who completed the MOTHER study. MEASUREMENTS: Smoking data and depression status were obtained from the Addiction Severity Index and Mini International Neuropsychiatric Interview, respectively. Neonatal outcomes (birth weight, preterm delivery and NAS pharmacologic treatment) were collected from the medical charts. Study site was a fixed-effect factor in all analyses. FINDINGS: Cigarette smoking was reported by 94% of participants and depression identified in 35%. Smoking was associated with low birth weight, preterm delivery, and NAS pharmacologic treatment in both depressed and non-depressed participants. The association between smoking and NAS treatment differed significantly between depressed and non-depressed participants. Among non-depressed participants, adjusting for site and illicit drug use, each additional average cigarette per day (CPD) increased the odds of NAS treatment by 12% [95%CI: (1.02-1.23), p=0.02]. Among depressed participants, each additional average CPD did not statistically increase the odds of NAS treatment [OR: 0.94, 95% CI: (0.84-1.04), p=0.23]. CONCLUSIONS: These results are consistent with the hypothesis that NAS expression is influenced by many factors. The relationship between CPD and NAS pharmacologic treatment is attenuated among depressed women in this study for reasons currently unknown. Further investigations are needed to clarify the complex relationships among maternal smoking, depression, and NAS.
研究吸烟和/或抑郁症是否会导致新生儿戒断综合征（NAS）的严重程度。
队列研究，分析美沙酮与丁丙诺啡随机对照试验的数据。
七个研究地点，将患者随机分组并为孕妇提供全面的成瘾治疗。
131名阿片类药物依赖孕妇中完成MOTHER研究的119名。
吸烟数据和抑郁状态分别从成瘾严重程度指数和迷你国际神经精神病学访谈中获取。新生儿结局（出生体重、早产和NAS药物治疗）从病历中收集。研究地点在所有分析中均为固定效应因素。
94%的参与者报告有吸烟，35%被诊断为抑郁症。吸烟与低出生体重、早产以及抑郁和非抑郁参与者的NAS药物治疗有关。抑郁和非抑郁参与者中吸烟与NAS治疗之间的关联存在显著差异。在非抑郁参与者中，调整研究地点和非法药物使用因素后，每天平均多吸一支烟（CPD）使NAS治疗的几率增加12%[95%置信区间：（1.02 - 1.23），p = 0.02]。在抑郁参与者中，每天平均多吸一支烟并未使NAS治疗的几率有统计学意义的增加[比值比：0.94，95%置信区间：（0.84 - 1.04），p = 0.23]。
这些结果与NAS的表现受多种因素影响这一假设一致。本研究中，抑郁女性中CPD与NAS药物治疗之间的关系减弱，原因尚不清楚。需要进一步研究以阐明母亲吸烟、抑郁和NAS之间的复杂关系。
