Johnson Shakevia, Martin Peter R
a Department of Psychiatry , Vanderbilt University Medical Center , Nashville , TN , USA.
Am J Drug Alcohol Abuse. 2018;44(3):310-316. doi: 10.1080/00952990.2017.1363218. Epub 2017 Aug 22.
Opioid use disorder during pregnancy is a growing health concern. Methadone maintenance is the treatment of choice but emerging data indicate buprenorphine is a viable alternative. Due to costs and limited accessibility of methadone, pregnant women may require transition from methadone to buprenorphine for maintenance treatment.
To assess safety and effectiveness of transitioning from methadone to buprenorphine when necessary during pregnancy.
A standardized protocol using low buprenorphine doses to minimize emergent withdrawal symptoms under careful obstetric and psychiatric monitoring was implemented in 20 pregnant women. Outpatient maternal and neonatal outcomes were assessed.
Women maintained on an average methadone dose of 44 ± 4.77 (20-100) mg/day (mean±standard error mean (SEM); range) were successfully transitioned to 12.60 ± 0.8 (8-16) mg/day (mean±SEM; range) of buprenorphine. Within 4 weeks of transition, 15% had illicit drugs detected in urine drug screens. Ninety percent of women maintained outpatient follow-up until delivery. At delivery, 38.9% of mothers were exclusively adherent to buprenorphine (without use of illicit substances and/or other psychotropic medications); this resulted in significantly lower rates of neonatal abstinence syndrome (NAS) and shorter hospital stays.
Pregnant women transitioned from methadone to buprenorphine maintenance showed maternal and neonatal outcomes comparable to studies of women on buprenorphine throughout pregnancy. Infants born to buprenorphine-maintained women who abstained from illicit substances and other prescribed psychotropic medications experienced less severe NAS and shorter hospitalizations compared with women with illicit substance use and other psychotropic medications. These findings suggest women can safely be transitioned from methadone to buprenorphine during pregnancy.
孕期阿片类药物使用障碍是一个日益受到关注的健康问题。美沙酮维持治疗是首选治疗方法，但新出现的数据表明丁丙诺啡是一种可行的替代方案。由于美沙酮成本高且可及性有限，孕妇可能需要从美沙酮转换为丁丙诺啡进行维持治疗。
评估孕期必要时从美沙酮转换为丁丙诺啡的安全性和有效性。
在20名孕妇中实施了一项标准化方案，使用低剂量丁丙诺啡以在仔细的产科和精神科监测下尽量减少戒断症状。评估门诊产妇和新生儿结局。
平均美沙酮剂量为44±4.77（20 - 100）mg/天（平均值±标准误平均值（SEM）；范围）的女性成功转换为12.60±0.8（8 - 16）mg/天（平均值±SEM；范围）的丁丙诺啡。转换后4周内，15%的女性尿液药物筛查中检测出非法药物。90%的女性维持门诊随访直至分娩。分娩时，38.9%的母亲完全坚持使用丁丙诺啡（未使用非法物质和/或其他精神药物）；这导致新生儿戒断综合征（NAS）发生率显著降低且住院时间缩短。
从美沙酮转换为丁丙诺啡维持治疗的孕妇，其产妇和新生儿结局与整个孕期使用丁丙诺啡的女性研究结果相当。与使用非法物质和其他精神药物的女性相比，坚持使用丁丙诺啡且未使用非法物质和其他处方精神药物的女性所生婴儿的NAS症状较轻，住院时间较短。这些发现表明，孕期女性可以安全地从美沙酮转换为丁丙诺啡。
