Viteri Oscar A, Mendez-Figueroa Hector, Pedroza Claudia, Leon Mateo G, Sibai Baha M, Chauhan Suneet P
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas.
Center for Clinical Research and Evidence-Based Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
Am J Perinatol. 2016 Jan;33(2):165-71. doi: 10.1055/s-0035-1563549. Epub 2015 Sep 7.
This study aims to compare neonatal and long-term outcomes among preterm newborns from women with reported versus those who did not report substance abuse.
Secondary analysis of a trial of magnesium sulfate for cerebral palsy prevention. Cases were pregnant women who reported substance abuse, controls were those who denied it. Study outcomes included (1) composite neonatal morbidity, defined as any of the following: Apgar score ≤ 3 at 5 minutes, seizures, culture-proven sepsis, necrotizing enterocolitis grades 2 or 3, intraventricular hemorrhage grades 3 or 4, and/or death before discharge; (2) infant and childhood morbidity, defined as stillbirth or death by 1 year, or moderate/severe cerebral palsy by age of 2.
Among 1,972 women meeting the inclusion criteria, 197 (10%) reported substance abuse. Composite neonatal, infant, and childhood morbidity rates were similar between cases and controls. However, women reporting substance abuse who delivered between 32(0/7) and 36(6/7) weeks had a higher frequency of composite infant and childhood morbidity (6.5 vs. 1.0%; adjusted odds ratio, 6.5; 95% confidence interval, 1.14-36.99).
Preterm birth was associated with similar composite neonatal morbidity between cases and controls. After 32 weeks, self-reported substance abuse was associated with a sevenfold increase in the rates of stillbirth and long-term infant morbidity.
本研究旨在比较报告有药物滥用史的孕妇所生早产新生儿与未报告有药物滥用史的孕妇所生早产新生儿的新生儿期及长期结局。
对一项预防脑瘫的硫酸镁试验进行二次分析。病例为报告有药物滥用史的孕妇，对照为否认有药物滥用史的孕妇。研究结局包括：（1）复合新生儿发病率，定义为以下任何一种情况：5分钟时阿氏评分≤3分、惊厥、经培养证实的败血症、2级或3级坏死性小肠结肠炎、3级或4级脑室内出血和/或出院前死亡；（2）婴儿期及儿童期发病率，定义为死产或1岁前死亡，或2岁时患中度/重度脑瘫。
在1972名符合纳入标准的女性中，197名（10%）报告有药物滥用史。病例组和对照组的复合新生儿发病率、婴儿期及儿童期发病率相似。然而，在32（0/7）至36（6/7）周分娩的报告有药物滥用史的女性中，复合婴儿期及儿童期发病率更高（6.5%对1.0%；调整后的优势比为6.5；95%置信区间为1.14 - 36.99）。
病例组和对照组的早产与相似的复合新生儿发病率相关。32周后，自我报告的药物滥用与死产率和婴儿长期发病率增加7倍相关。
