Departments of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #843, Little Rock, AR, 72205 USA.
College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR, 72205 USA.
Drug Alcohol Depend. 2018 Nov 1;192:146-149. doi: 10.1016/j.drugalcdep.2018.07.042. Epub 2018 Sep 15.
The treatment of pregnant women with opioid use disorder is challenging due to the myriad of physical, mental, and social complications. Factors influencing adherence to buprenorphine during pregnancy have not been identified.
Pregnant women with opioid use disorder followed in a tertiary clinic were included in a retrospective chart review from buprenorphine induction through delivery. All women who had been evaluated and treated with buprenorphine from January 1, 2014, to September 31, 2016, were included. Adherence was defined as follows: 1) adherent: attended follow up visits, negative urine toxicology screens, and phase advancement; 2) moderately adherent: attended follow up visits until delivery, had not completed six negative urine toxicology screens, or had positive urine toxicology screens (i.e., no phase advancement); 3) non-adherent: missed follow up visits and did not stay in treatment until delivery. Sociodemographic characteristics, family psychiatric history, current and lifetime psychiatric and childhood trauma along with treatment factors were compared by category of adherence.
64 women met criteria for inclusion in this study with 41 (64%) adherent; eight (13%) moderately adherent; and 15 (23%) non-adherent. In the non-adherent group compared to the adherent group, the clinician-rated opioid withdrawal scale score was significantly higher, and the daily buprenorphine dose at last visit was significantly lower.
Women who were non-adherent to buprenorphine during pregnancy had higher severity of opioid withdrawal symptoms and lower doses of buprenorphine. These findings should be further explored with the goal of optimizing care without increasing risk for neonates.
由于孕妇面临众多身体、心理和社会并发症，因此治疗患有阿片类药物使用障碍的孕妇具有挑战性。影响孕妇在怀孕期间使用丁丙诺啡的因素尚未确定。
在一家三级诊所接受治疗的患有阿片类药物使用障碍的孕妇纳入了一项回顾性图表审查，内容涵盖丁丙诺啡诱导至分娩的过程。所有在 2014 年 1 月 1 日至 2016 年 9 月 31 日期间接受过丁丙诺啡评估和治疗的女性均包括在内。依从性定义如下：1）依从性：定期随访、尿液毒理学检测阴性且逐步推进治疗；2）中度依从性：定期随访直至分娩，但未完成 6 次尿液毒理学检测阴性或尿液毒理学检测阳性（即无治疗阶段推进）；3）不依从性：错过随访且在分娩前未继续治疗。根据依从性类别比较社会人口统计学特征、家庭精神病史、当前和终生精神创伤和儿童创伤以及治疗因素。
64 名女性符合纳入本研究的标准，其中 41 名（64%）为依从性患者；8 名（13%）为中度依从性患者；15 名（23%）为不依从性患者。与依从性组相比，不依从组的临床医生评定的阿片类药物戒断量表评分明显更高，最后一次就诊时的丁丙诺啡日剂量明显更低。
在怀孕期间不依从丁丙诺啡的女性阿片类药物戒断症状更严重，丁丙诺啡剂量更低。应进一步探索这些发现，目标是在不增加新生儿风险的情况下优化护理。
