Hwang Sunah S, Diop Hafsatou, Liu Chia-Ling, Yu Qi, Babakhanlou-Chase Hermik, Cui Xiaohui, Kotelchuck Milton
Department of Neonatology, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Office of Data Translation, Massachusetts Department of Public Health, Boston, MA.
J Pediatr. 2017 Dec;191:69-75. doi: 10.1016/j.jpeds.2017.08.045. Epub 2017 Oct 16.
To determine the association of maternal substance use disorders (SUDs) during pregnancy with adverse neonatal outcomes and infant hospital re-admissions, observational stays, and emergency department utilization in the first year of life.
We analyzed 2 linked statewide datasets from 2002 to 2010: the Massachusetts Pregnancy to Early Life Longitudinal data system and the Massachusetts Bureau of Substance Abuse Services Management Information System. Generalized estimating equations were used to assess the association of maternal SUDs and neonatal outcomes and infant hospital-based care in the first year of life, controlling for maternal and infant characteristics.
Maternal SUDs increased from 19.4 per 1000 live births in 2003 to 31.1 per 1000 live births in 2009. In the adjusted analysis, exposed neonates were more likely to be born preterm (aOR 1.85; 95% CI 1.75-1.96) and low birthweight (aOR 1.94; 95% CI 1.80-2.09). After controlling for maternal characteristics and preterm birth, SUD-exposed neonates were more likely to have intrauterine growth restriction, cardiac, respiratory, neurologic, infectious, hematologic, and feeding/nutrition problems, prolonged hospital stay, and higher mortality (aOR range 1.26-3.80). Exposed infants were more likely to be rehospitalized (aOR 1.10; 95% CI 1.04-1.17) but less likely to have an observational stay (aOR 0.90; 95% CI 0.82-0.99) or use the emergency department (aOR 0.87; 95% CI 0.83-0.90) in the first year of life.
Infants born to mothers with SUD are at higher risk for adverse health outcomes in the perinatal period and are also more likely to be rehospitalized in the first year of life.
确定孕期母亲物质使用障碍（SUDs）与不良新生儿结局、婴儿1岁内再次入院、观察性住院以及急诊就诊之间的关联。
我们分析了2002年至2010年两个全州范围的关联数据集：马萨诸塞州孕期至生命早期纵向数据系统和马萨诸塞州物质滥用服务局管理信息系统。使用广义估计方程评估母亲SUDs与新生儿结局以及婴儿1岁内住院治疗之间的关联，并对母亲和婴儿特征进行控制。
母亲SUDs发生率从2003年每1000例活产中的19.4例增至2009年每1000例活产中的31.1例。在调整分析中，暴露的新生儿更有可能早产（校正优势比1.85；95%置信区间1.75 - 1.96）和低出生体重（校正优势比1.94；95%置信区间1.80 - 2.09）。在控制母亲特征和早产因素后，暴露于SUDs的新生儿更有可能出现宫内生长受限、心脏、呼吸、神经、感染、血液和喂养/营养问题、住院时间延长以及死亡率更高（校正优势比范围1.26 - 3.80）。暴露的婴儿在1岁内更有可能再次住院（校正优势比1.10；95%置信区间1.04 - 1.17），但观察性住院（校正优势比0.90；95%置信区间0.82 - 0.99）或急诊就诊（校正优势比0.87；95%置信区间0.83 - 0.90）的可能性较小。
母亲患有SUDs的婴儿在围产期出现不良健康结局的风险更高，并且在1岁内再次住院的可能性也更大。
