Alaska Native Medical Center, Anchorage, AK, USA.
University of Colorado, Department of Family Medicine, 1693 N Quentin Street, Aurora, CO, USA.
Semin Perinatol. 2019 Apr;43(3):141-148. doi: 10.1053/j.semperi.2019.01.003. Epub 2019 Jan 21.
Pharmacotherapy, or medication-assisted treatment (MAT), is a critical component of a comprehensive treatment plan for the pregnant woman with opioid use disorder (OUD). Methadone and buprenorphine are two types of opioid-agonist therapy which prevent withdrawal symptoms and control opioid cravings. Methadone is a long-acting mu-opioid receptor agonist that has been shown to increase retention in treatment programs and attendance at prenatal care while decreasing pregnancy complications. However methadone can only be administered by treatment facilities when used for OUD. In contrast, buprenorphine is a mixed opioid agonist-antagonist medication that can be prescribed outpatient. The decision to use methadone vs buprenorphine for MAT should be individualized based upon local resources and a patient-specific factors. There are limited data on the use of the opioid antagonist naltrexone in pregnancy. National organizations continue to recommend MAT over opioid detoxification during pregnancy due to higher rates of relapse with detoxification.
药物治疗，或药物辅助治疗（MAT），是患有阿片类药物使用障碍（OUD）的孕妇综合治疗计划的重要组成部分。美沙酮和丁丙诺啡是两种阿片类激动剂治疗方法，可预防戒断症状和控制阿片类药物的渴望。美沙酮是一种长效μ-阿片受体激动剂，已被证明可增加治疗计划的保留率和产前保健的出勤率，同时减少妊娠并发症。然而，美沙酮只能在用于 OUD 时由治疗设施管理。相比之下，丁丙诺啡是一种混合阿片类激动剂-拮抗剂药物，可在门诊开处方。基于当地资源和患者具体情况，应个体化决定使用美沙酮与丁丙诺啡进行 MAT。在怀孕期间使用阿片类拮抗剂纳曲酮的数据有限。由于戒断后复发率较高，国家组织继续建议在怀孕期间进行 MAT 而不是阿片类药物解毒。
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