Institute of Public Health, National Yang-Ming University, Taiwan; Center of Neuropsychiatric Research, National Health Research Institutes, Taiwan.
Center of Neuropsychiatric Research, National Health Research Institutes, Taiwan.
Int J Drug Policy. 2015 Feb;26(2):191-8. doi: 10.1016/j.drugpo.2014.07.012. Epub 2014 Jul 30.
To identify sociodemographic and clinical factors predicting the overall risk of adverse obstetric outcomes and the length of maternal hospital stay among heroin-exposed and methadone-treated women in Taiwan.
Using the retrospective matched cohort study design, 396 births to women on methadone treatment during pregnancy (the methadone-treated group) and 609 to women who started methadone treatment after childbirth (the heroin-exposed group) were identified in the National Methadone Maintenance Program. Adverse pregnancy outcomes were assessed by still birth, low birth weight and preterm delivery. We used multivariate methods and zero-truncated negative binomial regression to evaluate association estimates.
Both heroin-exposed and methadone-treated women had 2-4-fold greater risk of adverse pregnancy outcomes. HIV infection increased the overall risk of adverse pregnancy outcome in the methadone-treated group, whereas being unmarried and having treatment history of substance use disorders increased such risk in the heroin-exposed group. Maternal ages at delivery and healthcare facility used had moderate effects on the length of maternal hospital stay; HIV infection significantly increased the length of hospital stay for women in the heroin-exposed group (adjusted relative risk=1.32, 95% CI=1.05-1.68).
Our results showed no appreciable differences in the occurrence of adverse obstetric outcomes and the length of maternity hospitalization between the methadone-treated and the heroin-exposed women; the profile of sociodemographic and clinical predictors was similar as well. Coordination of addiction treatment and prenatal care may help reduce unfavorable obstetric outcomes among female heroin addicts seeking substitution treatment.
确定社会人口学和临床因素，预测在台湾接受美沙酮治疗的海洛因暴露和使用女性的不良产科结局的总体风险和产妇住院时间。
使用回顾性匹配队列研究设计，在全国美沙酮维持治疗计划中确定了 396 例接受美沙酮治疗的孕妇（美沙酮治疗组）和 609 例产后开始接受美沙酮治疗的孕妇（海洛因暴露组）的分娩情况。通过死产、低出生体重和早产来评估不良妊娠结局。我们使用多变量方法和零截断负二项回归来评估关联估计。
海洛因暴露和接受美沙酮治疗的女性发生不良妊娠结局的风险均增加了 2-4 倍。艾滋病毒感染增加了美沙酮治疗组不良妊娠结局的总体风险，而未婚和有药物使用障碍治疗史则增加了海洛因暴露组的这种风险。产妇分娩年龄和使用的医疗保健机构对产妇住院时间有中等影响；艾滋病毒感染显著增加了海洛因暴露组女性的住院时间（调整后的相对风险=1.32，95%CI=1.05-1.68）。
我们的结果表明，接受美沙酮治疗和海洛因暴露的女性在不良产科结局的发生和产妇住院时间方面没有明显差异；社会人口学和临床预测因素的特征也相似。协调成瘾治疗和产前保健可能有助于减少寻求替代治疗的女性海洛因成瘾者的不良产科结局。
