Patrick Stephen W, Dudley Judith, Martin Peter R, Harrell Frank E, Warren Michael D, Hartmann Katherine E, Ely E Wesley, Grijalva Carlos G, Cooper William O
Departments of Pediatrics, Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee; Health Policy,
Health Policy.
Pediatrics. 2015 May;135(5):842-50. doi: 10.1542/peds.2014-3299. Epub 2015 Apr 13.
Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS).
We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.
Of 112,029 pregnant women, 31,354 (28%) filled ≥ 1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P < .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P < .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P < .001), opioid type (P < .001), number of daily cigarettes smoked (P < .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67-2.60]) were associated with greater risk of developing NAS.
Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS.
尽管阿片类镇痛药在孕期常用，但它们与新生儿结局的关联描述甚少。我们的目的是确定与产前暴露于阿片类镇痛药相关的新生儿并发症，并确定新生儿戒断综合征（NAS）的预测因素。
我们使用了与2009年至2011年田纳西州医疗补助计划中母亲和婴儿的生命统计数据相关的处方和管理数据。通过病历审查对NAS病例的随机样本进行了验证。使用多变量逻辑回归评估产前暴露与NAS的关联，并对母婴特征进行控制。
在112,029名孕妇中，31,354名（28%）开具了≥1张阿片类处方。开具阿片类镇痛药的女性比未开具阿片类药物的女性更有可能患抑郁症（5.3%对2.7%）、焦虑症（4.3%对1.6%）和吸烟（41.8%对25.8%）（P<.001）。与未暴露的婴儿相比，患有NAS的婴儿和暴露于阿片类药物的婴儿更有可能出生时低体重（21.2%对11.8%对9.9%；P<.001）。在多变量模型中，短效制剂的阿片类药物累积暴露量较高（P<.001）、阿片类药物类型（P<.001）、每日吸烟量（P<.001）以及使用选择性5-羟色胺再摄取抑制剂（比值比：2.08[95%置信区间：1.67-2.60]）与发生NAS的风险较高相关。
孕期使用处方阿片类药物很常见，且与新生儿并发症密切相关。产前累积处方阿片类药物暴露、阿片类药物类型、吸烟以及使用选择性5-羟色胺再摄取抑制剂会增加NAS的风险。
