Coombe Women and Infants University Hospital, Dublin 8, Ireland.
Addiction. 2013 Apr;108(4):762-70. doi: 10.1111/add.12078. Epub 2013 Feb 11.
This study aimed to (i) describe methadone dosing before, during and after pregnancy, (ii) to compare the incidence of neonatal abstinence syndrome (NAS) between those with dose decreases and those with steady or increasing doses and (iii) to describe prescribed medication use among opioid-dependent pregnant women.
Prospective cohort study.
Two Irish tertiary care maternity hospitals.
A total of 117 pregnant women on methadone maintenance treatment (MMT) recruited between July 2009 and July 2010.
Electronic dispensing records from addiction clinics and the Primary Care Reimbursement Service were used to determine methadone doses and dispensed medications in the year preceding and the month following delivery. The Finnegan score was used to determine need for medical treatment of NAS.
Of the 117 participants, sufficient dosing data were available for 89 women treated with MMT throughout pregnancy; 36 (40.4%) had their dose decreased from a mean pre-pregnancy dose of 73.3 mg [standard deviation (SD) 25.5] to a third-trimester dose of 58.0 mg (SD 26.0). The corresponding figures for those with increased doses (n = 31, 34.8%) were 70.7 mg (SD 25.3) and 89.7 mg (SD 21.0), respectively. The incidence of medically treated NAS did not differ between dosage groups. Antidepressants were dispensed for 29 women (25.7%) during pregnancy, with the rate decreasing from pre-pregnancy to postpartum. Benzodiazepines were prescribed for 43 women (38.0%).
In the Irish health service, opioid-dependent women frequently have their methadone dose decreased during pregnancy but this does not appear to affect the incidence of the neonatal abstinence syndrome in their babies.
本研究旨在：(i) 描述孕妇在怀孕前后的美沙酮剂量；(ii) 比较剂量减少组与剂量稳定或增加组新生儿戒断综合征（NAS）的发生率；(iii) 描述阿片类药物依赖孕妇的处方药物使用情况。
前瞻性队列研究。
爱尔兰两家三级保健妇产医院。
2009 年 7 月至 2010 年 7 月期间招募的 117 名接受美沙酮维持治疗（MMT）的孕妇。
从成瘾诊所和初级保健报销服务的电子配药记录中确定孕妇在怀孕前一年和分娩后一个月的美沙酮剂量和配药药物。芬纳根评分用于确定 NAS 是否需要医疗治疗。
在 117 名参与者中，有 89 名接受 MMT 治疗的孕妇有足够的剂量数据；36 名（40.4%）的剂量从孕前的平均剂量 73.3mg（SD 25.5）减少到孕晚期的 58.0mg（SD 26.0）。剂量增加（n = 31，34.8%）的相应数值分别为 70.7mg（SD 25.3）和 89.7mg（SD 21.0）。两组的 NAS 发生率无差异。29 名孕妇（25.7%）在怀孕期间开了抗抑郁药，从孕前到产后，这一比例下降。43 名妇女（38.0%）开了苯二氮䓬类药物。
在爱尔兰卫生服务中，阿片类药物依赖的孕妇经常减少美沙酮剂量，但这似乎不会影响其婴儿中新生儿戒断综合征的发生率。
