Krans Elizabeth E, Zickmund Susan L, Rustgi Vinod K, Park Seo Young, Dunn Shannon L, Schwarz Eleanor B
a Department of Obstetrics , Gynecology and Reproductive Sciences , University of Pittsburgh School of Medicine , Pittsburgh , Pennsylvania , USA.
b Magee-Womens Research Institute , Pittsburgh , Pennsylvania , USA.
Subst Abus. 2016;37(1):88-95. doi: 10.1080/08897077.2015.1118720. Epub 2015 Nov 16.
The purpose of this study was to describe the delivery of prenatal care services to women with opioid use disorder (OUD) on opioid maintenance therapy at high risk for hepatitis C virus (HCV) infection.
We conducted a retrospective cohort evaluation of 791 pregnant women with OUD from 2009 to 2012. HCV screening was defined as documentation of (a) an anti-HCV antibody test or (b) a provider discussion regarding a known HCV diagnosis during pregnancy. Multivariate logistic regression was used to identify predictors of HCV screening during pregnancy.
Among 791 pregnant women with OUD, 611 (77.2%) were screened for HCV infection and 369/611 (60.4%) were HCV positive. In multivariable analysis, patients who were married (odds ratio [OR] = 0.52; 95% confidence interval [CI] = 0.29, 0.91), used buprenorphine (OR = 0.45; 95% CI = 0.28, 0.71), and were cared for by private practice providers (OR = 0.29; 95% CI = 0.19, 0.45) were significantly less likely to be screened. In contrast, patients who used benzodiazepines (OR = 1.72; 95% CI = 1.02, 2.92), intravenous (IV) opioids (OR = 6.15; 95% CI = 3.96, 9.56), had legal problems (OR = 2.23; 95% CI = 1.12, 4.45), had children not in their custody (OR = 1.81; 95% CI = 1.01, 3.24), and who had a partner with substance abuse history (OR = 2.38; 95% CI = 1.23, 4.59) were significantly more likely to be screened. Of 369 HCV-positive patients, a new diagnosis of HCV was made during pregnancy for 108 (29.3%) patients. Only 94 (25.5%) had HCV viral load testing, 61 (16.5%) had HCV genotype testing, and 38 (10.4%) received an immunization for hepatitis A. Although 285 (77.2%) patients were referred to hepatology, only 71 (24.9%) attended the consultation. Finally, only 6 (1.6%) patients received HCV treatment 1 year following delivery.
Prenatal care approaches to HCV infection remain inconsistent, and the majority of patients diagnosed with HCV infection during pregnancy do not receive treatment after delivery.
本研究的目的是描述为丙型肝炎病毒（HCV）感染高风险的阿片类物质使用障碍（OUD）孕妇提供产前护理服务的情况。
我们对2009年至2012年期间的791名患有OUD的孕妇进行了回顾性队列评估。HCV筛查定义为记录以下情况之一：（a）抗HCV抗体检测；或（b）孕期医护人员就已知的HCV诊断进行的讨论。采用多因素逻辑回归分析来确定孕期HCV筛查的预测因素。
在791名患有OUD的孕妇中，611名（77.2%）接受了HCV感染筛查，其中369/611名（60.4%）HCV呈阳性。在多变量分析中，已婚患者（比值比[OR]=0.52；95%置信区间[CI]=0.29，0.91）、使用丁丙诺啡的患者（OR=0.45；95%CI=0.28，0.71）以及由私人执业医护人员护理的患者（OR=0.29；95%CI=0.19，0.45）接受筛查的可能性显著较低。相比之下，使用苯二氮䓬类药物的患者（OR=1.72；95%CI=1.02，2.92）、静脉注射阿片类药物的患者（OR=6.15；95%CI=3.96，9.56）、有法律问题的患者（OR=2.23；95%CI=1.12，4.45）、孩子不在其监护下的患者（OR=1.81；95%CI=1.01，3.24）以及伴侣有药物滥用史的患者（OR=2.38；95%CI=1.23，4.59）接受筛查的可能性显著较高。在369名HCV阳性患者中，108名（29.3%）患者在孕期被新诊断为HCV。只有94名（25.5%）患者进行了HCV病毒载量检测，61名（16.5%）患者进行了HCV基因分型检测，38名（10.4%）患者接种了甲型肝炎疫苗。尽管285名（77.2%）患者被转诊至肝病科，但只有71名（24.9%）患者参加了会诊。最后，只有6名（1.6%）患者在分娩后1年接受了HCV治疗。
针对HCV感染的产前护理方法仍然不一致，大多数在孕期被诊断为HCV感染的患者在分娩后未接受治疗。
