Smith Megan V, Costello Darce, Yonkers Kimberly A
Department of Psychiatry, Yale School of Medicine, 300 George Street, 9th floor, New Haven, CT, 06511, USA,
Matern Child Health J. 2015 Mar;19(3):548-56. doi: 10.1007/s10995-014-1536-6.
A 2012 committee opinion from the American College of Obstetricians and Gynecologists highlights the considerable increase in opioid addiction in recent years, yet little is known about clinical correlates of prescribed opioids among pregnant women. This study examines clinical and demographic factors associated with the use of opioid analgesics in pregnancy. Data were derived from a prospective cohort study of pregnant women. Participants were administered the Composite International Diagnostic Interview to identify depressive and anxiety disorders and data on medication use were gathered at three assessment points and classified according to the Anatomical Therapeutic Chemical Code (ATC) classification system ATC group N02A. Participants included 2,748 English or Spanish speaking pregnant women. Six percent (n = 165) of women used opioid analgesics at any point in pregnancy. More pregnant women using opioids met diagnostic criteria for major depressive disorder (16 vs. 8 % for non users), generalized anxiety disorder (18 vs. 9 % for non users), post-traumatic stress disorder (11 vs. 4 % for non users) and panic disorder (6 vs. 4 % for non users). Women who reported opioid use were also significantly more likely than non users to report using illicit drugs and almost three times as likely to report smoking cigarettes in the second or third trimester of pregnancy (4 and 23 %, respectively) as compared to non-opioid users (0.5 and 8 %). The use of opioids in pregnancy was associated with higher levels of psychiatric comorbidity and use of other substances as compared to non-opioid users.
美国妇产科医师学会2012年的一份委员会意见强调了近年来阿片类药物成瘾现象的显著增加，但对于孕妇中开具的阿片类药物的临床相关因素却知之甚少。本研究调查了与孕期使用阿片类镇痛药相关的临床和人口统计学因素。数据来源于一项针对孕妇的前瞻性队列研究。参与者接受了综合国际诊断访谈以确定抑郁和焦虑症，并在三个评估点收集用药数据，并根据解剖治疗化学代码（ATC）分类系统ATC组N02A进行分类。参与者包括2748名讲英语或西班牙语的孕妇。6%（n = 165）的女性在孕期的任何时候使用过阿片类镇痛药。更多使用阿片类药物的孕妇符合重度抑郁症的诊断标准（使用者为16%，非使用者为8%）、广泛性焦虑症（使用者为18%，非使用者为9%）、创伤后应激障碍（使用者为11%，非使用者为4%）和惊恐障碍（使用者为6%，非使用者为4%）。报告使用阿片类药物的女性比非使用者报告使用非法药物的可能性也显著更高，并且在妊娠中期或晚期报告吸烟的可能性几乎是非阿片类药物使用者的三倍（分别为4%和23%），而非阿片类药物使用者为0.5%和8%。与非阿片类药物使用者相比，孕期使用阿片类药物与更高水平的精神疾病共病和其他物质的使用有关。
