McCarthy John J, Leamon Martin H, Willits Neil H, Salo Ruth
From the Bi-Valley Medical Clinic, Carmichael, CA (JJM); and Departments of Psychiatry and Behavioral Sciences (JJM, MHL, RS) and Statistics (NHW), University of California, Davis.
J Addict Med. 2015 Mar-Apr;9(2):105-10. doi: 10.1097/ADM.0000000000000099.
To evaluate the effects of a multiple daily dose methadone regimen in pregnancy on neonatal outcomes.
Although methadone maintenance has been the standard for the treatment of opioid dependence in pregnancy, there is no consensus on proper dosing. Single daily dosing is the most common strategy. Because of accelerated metabolism of methadone in pregnancy, this regimen may expose mother and fetus to daily episodes of withdrawal and possibly contribute to more severe Neonatal Abstinence Syndrome (NAS). This study reports on a protocol that increased both methadone dose and dose frequency in response to maternal reports of withdrawal.
Treatment of NAS was needed in 29% of neonates, compared to a published rate of 60% to 80%. The mean methadone dose was 152 mg at delivery, divided into 2 to 6 doses per day. Ninety-two percent of mothers were free of illicit drug use at delivery. There was no relationship between methadone dose and treatment of NAS. Female babies had a treatment rate of 16% versus 38% for male babies. Beyond abstinence symptoms, cohort outcomes in terms of gestational age, birth weight, prematurity, Caesarian sections, and breastfeeding equaled or approximated US population norms.
The protocol was associated with low rates of treatment of NAS and high rates of maternal recovery. High rates of treatment for NAS reported in methadone-exposed neonates might relate in part to iatrogenic factors and be reduced through the use of divided daily doses and protocols that minimize maternal withdrawal.
评估孕期每日多次服用美沙酮方案对新生儿结局的影响。
尽管美沙酮维持治疗一直是孕期阿片类药物依赖治疗的标准方法，但在合适剂量方面尚无共识。每日单次给药是最常见的策略。由于孕期美沙酮代谢加快，该方案可能使母亲和胎儿每日经历戒断反应，并可能导致更严重的新生儿戒断综合征（NAS）。本研究报告了一项根据母亲的戒断报告增加美沙酮剂量和给药频率的方案。
29%的新生儿需要接受NAS治疗，而公布的发生率为60%至80%。分娩时美沙酮的平均剂量为152毫克，分为每日2至6次给药。92%的母亲在分娩时未使用非法药物。美沙酮剂量与NAS治疗之间没有关系。女婴的治疗率为16%，男婴为38%。除了戒断症状外，该队列在胎龄、出生体重、早产、剖宫产和母乳喂养方面的结局等于或接近美国人群规范。
该方案与NAS低治疗率和母亲高康复率相关。美沙酮暴露新生儿中报道的高NAS治疗率可能部分与医源性因素有关，通过每日分剂量给药和尽量减少母亲戒断的方案可降低该治疗率。
