Department of Community and Public Health, Johns Hopkins University, Baltimore, Maryland.
J Midwifery Womens Health. 2019 Sep;64(5):545-558. doi: 10.1111/jmwh.12982. Epub 2019 Jul 11.
Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations.
CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy.
Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers.
Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population.
在美国，阿片类药物的使用已呈流行趋势。在过去十年中，妊娠阿片类药物使用障碍（OUD）以及新生儿戒断综合征的发病率增加了两倍，对于患有 OUD 的孕妇，推荐使用阿片类药物维持疗法。母乳喂养是改善这些脆弱的母婴群体预后的重要手段。本研究旨在综述当前关于母乳喂养和阿片类药物维持疗法的政策、该人群中母乳喂养的比例，以及实施政策建议的促进因素和障碍。
检索 CINAHL、PubMed、Cochrane 系统评价数据库、Embase 和 Web of Science。纳入标准包括 2013 年至 2018 年发表的英文文献、研究对象仅限人类、原始数据（除政策声明外）。如果研究未报告原始数据且未考察阿片类药物维持治疗女性的母乳喂养情况，则将其排除。
共确定了 8 项政策声明和 17 项符合检索条件的原始研究。所有的政策声明均支持稳定使用阿片类药物维持治疗且未感染 HIV 的女性进行母乳喂养。尽管如此，与普通人群相比，接受阿片类药物维持治疗的女性母乳喂养率仍然较低。定性研究结果表明，接受阿片类药物维持治疗的女性在母乳喂养方面面临诸多障碍，包括医护人员提供的错误信息。定量研究才刚刚开始确定改善该人群母乳喂养结果的干预措施。研究主要在接受城市医疗中心护理的白人女性中进行。
在支持接受阿片类药物维持治疗的女性进行母乳喂养方面，实践落后于政策。需要开展更多研究，包括接受阿片类药物维持治疗的非裔美国人和农村女性，以及使用定性研究结果确定改善接受阿片类药物维持治疗的女性及其新生儿母乳喂养结果的最佳干预措施的定量研究。一个重要的需求是对医护人员进行这些政策以及为该人群提供母乳喂养教育和支持的最佳实践的教育。
