孕期阿片类药物滥用和依赖：时间趋势和产科结局。
Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes.
机构信息
From the Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.M., C.R.C., L.R.L.); Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (B.T.B.); and Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (A.A.C.).
出版信息
Anesthesiology. 2014 Dec;121(6):1158-65. doi: 10.1097/ALN.0000000000000472.
BACKGROUND
The authors investigated nationwide trends in opioid abuse or dependence during pregnancy and assessed the impact on maternal and obstetrical outcomes in the United States.
METHODS
Hospitalizations for delivery were extracted from the Nationwide Inpatient Sample from 1998 to 2011. Temporal trends were assessed and logistic regression was used to examine the associations between maternal opioid abuse or dependence and obstetrical outcomes adjusting for relevant confounders.
RESULTS
The prevalence of opioid abuse or dependence during pregnancy increased from 0.17% (1998) to 0.39% (2011) for an increase of 127%. Deliveries associated with maternal opioid abuse or dependence compared with those without opioid abuse or dependence were associated with an increased odds of maternal death during hospitalization (adjusted odds ratio [aOR], 4.6; 95% CI, 1.8 to 12.1, crude incidence 0.03 vs. 0.006%), cardiac arrest (aOR, 3.6; 95% CI, 1.4 to 9.1; 0.04 vs. 0.01%), intrauterine growth restriction (aOR, 2.7; 95% CI, 2.4 to 2.9; 6.8 vs. 2.1%), placental abruption (aOR, 2.4; 95% CI, 2.1 to 2.6; 3.8 vs. 1.1%), length of stay more than 7 days (aOR, 2.2; 95% CI, 2.0 to 2.5; 3.0 vs. 1.2%), preterm labor (aOR, 2.1; 95% CI, 2.0 to 2.3; 17.3 vs. 7.4%), oligohydramnios (aOR, 1.7; 95% CI, 1.6 to 1.9; 4.5 vs. 2.8%), transfusion (aOR, 1.7; 95% CI, 1.5 to 1.9; 2.0 vs. 1.0%), stillbirth (aOR, 1.5; 95% CI, 1.3 to 1.8; 1.2 vs. 0.6%), premature rupture of membranes (aOR, 1.4; 95% CI, 1.3 to 1.6; 5.7 vs. 3.8%), and cesarean delivery (aOR, 1.2; 95% CI, 1.1 to 1.3; 36.3 vs. 33.1%).
CONCLUSIONS
Opioid abuse or dependence during pregnancy is associated with considerable obstetrical morbidity and mortality, and its prevalence is dramatically increasing in the United States. Identifying preventive strategies and therapeutic interventions in pregnant women who abuse drugs are important priorities for clinicians and scientists.
背景
作者研究了美国怀孕期间阿片类药物滥用或依赖的全国性趋势，并评估了其对产妇和产科结局的影响。
方法
从 1998 年至 2011 年的全国住院患者样本中提取分娩住院数据。评估了时间趋势，并使用逻辑回归检查了调整了相关混杂因素后，产妇阿片类药物滥用或依赖与产科结局之间的关联。
结果
怀孕期间阿片类药物滥用或依赖的患病率从 0.17%（1998 年）增加到 0.39%（2011 年），增加了 127%。与没有阿片类药物滥用或依赖的产妇相比，与阿片类药物滥用或依赖相关的分娩与住院期间产妇死亡的几率增加有关（调整后的优势比[aOR]，4.6；95%置信区间[CI]，1.8 至 12.1；粗发病率 0.03 与 0.006%），心脏骤停（aOR，3.6；95%CI，1.4 至 9.1；0.04 与 0.01%），宫内生长受限（aOR，2.7；95%CI，2.4 至 2.9；6.8 与 2.1%），胎盘早剥（aOR，2.4；95%CI，2.1 至 2.6；3.8 与 1.1%），住院时间超过 7 天（aOR，2.2；95%CI，2.0 至 2.5；3.0 与 1.2%），早产（aOR，2.1；95%CI，2.0 至 2.3；17.3 与 7.4%），羊水过少（aOR，1.7；95%CI，1.6 至 1.9；4.5 与 2.8%），输血（aOR，1.7；95%CI，1.5 至 1.9；2.0 与 1.0%），死产（aOR，1.5；95%CI，1.3 至 1.8；1.2 与 0.6%），胎膜早破（aOR，1.4；95%CI，1.3 至 1.6；5.7 与 3.8%）和剖宫产（aOR，1.2；95%CI，1.1 至 1.3；36.3 与 33.1%）。
结论
怀孕期间阿片类药物滥用或依赖与产妇发病率和死亡率有很大关系，其在美国的流行率正在急剧上升。确定吸毒孕妇的预防策略和治疗干预措施是临床医生和科学家的重要优先事项。
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