Saia Kelley A, Schiff Davida, Wachman Elisha M, Mehta Pooja, Vilkins Annmarie, Sia Michelle, Price Jordana, Samura Tirah, DeAngelis Justin, Jackson Clark V, Emmer Sawyer F, Shaw Daniel, Bagley Sarah
Department of Obstetrics and Gynecology, Boston Medical Center, 85 East Concord Street, 6th Floor, Boston, MA 02118 USA.
Department of Pediatrics, Boston Medical Center, Boston, USA.
Curr Obstet Gynecol Rep. 2016;5(3):257-263. doi: 10.1007/s13669-016-0168-9. Epub 2016 Jul 1.
Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population.
We review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal ("detoxification") is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad.
Further research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.
美国阿片类药物使用障碍的发生率正以惊人的速度上升，尤其是在育龄女性中。患有阿片类药物使用障碍的孕妇在接受治疗时面临诸多障碍，包括治疗途径有限、耻辱感以及对法律后果的担忧。本综述旨在帮助为孕妇和产后女性提供护理的医疗服务提供者，以扩大针对这一弱势群体的循证治疗方法。
我们回顾了美国女性阿片类药物使用障碍的现有文献、围绕孕期物质使用的现行立法以及患有阿片类药物使用障碍的孕妇可采用的治疗方案。阿片类激动剂治疗（OAT）仍然是治疗孕期阿片类药物使用障碍的护理标准。孕期不建议进行药物辅助的阿片类药物脱毒（“戒毒”），且其与较高的产妇复发率相关。缓释纳曲酮可能对精心挑选的患者有益。创伤史和精神健康障碍在这一人群中很常见；最佳实践建议纳入了针对性别、创伤知情的精神健康服务。采用OAT进行母乳喂养对母婴二元组是安全且有益的。
需要进一步研究孕期OAT的选择以及阿片类拮抗剂的疗效。美国医疗保健系统可以通过扩大综合治疗服务并改善就医途径，来适应为这些母婴二元组提供优质护理。
