产妇孕前手术与未来新生儿戒断综合征风险：一项纵向队列研究。

Maternal prepregnancy surgery and risk of neonatal abstinence syndrome in future newborns: a longitudinal cohort study.

机构信息

University of Montreal Hospital Research Centre (Auger, Carrier, Ayoub), School of Public Health; Institut national de santé publique du Québec (Auger, Ayoub); Department of Psychiatry (Low), McGill University; Departments of Anesthesiology and Medicine (Carrier), Critical Care Division, University of Montreal Hospital; Department of Pediatrics (Luu), Sainte-Justine Hospital Research Centre, University of Montreal, Montréal, Que.

出版信息

CMAJ. 2019 Jul 15;191(28):E779-E786. doi: 10.1503/cmaj.181519.

DOI:10.1503/cmaj.181519

PMID:31308006

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6629530/

Abstract

BACKGROUND

Neonatal abstinence syndrome is increasingly prevalent, and may be related to opioid use disorders caused by postoperative prescriptions for pain control. We assessed the association of maternal prepregnancy surgery with risk of neonatal abstinence syndrome from opioid use disorders in future pregnancies.

METHODS

We conducted a longitudinal retrospective cohort study of 2 182 365 deliveries in Quebec, Canada, between 1989 and 2016. The main exposure was maternal prepregnancy surgery. The main outcome measure was neonatal abstinence syndrome in offspring. We adjusted associations for maternal comorbidity and pregnancy characteristics using log-binomial regression models.

RESULTS

The prevalence of neonatal abstinence syndrome in the cohort was 10.7 per 10 000 births. Compared with no surgery, prepregnancy surgery was associated with a risk ratio (RR) of neonatal abstinence syndrome of 1.63 (95% confidence interval [CI] 1.49-1.78). Risk was greater for 3 or more prepregnancy surgeries (RR 2.34, 95% CI 2.07-2.63) and age < 15 years at first surgery (1 surgery: RR 2.08, 95% CI 1.71-2.54; 2 or more surgeries: RR 2.79, 95% CI 2.32-3.37). Nearly all surgical specialties increased the risk of neonatal abstinence syndrome, but associations were strongest for cardiothoracic surgery (RR 4.45, 95% CI 2.87-6.91), neurosurgery (RR 3.00, 95% CI 1.56-5.77) and urologic surgery (RR 3.03, 95% CI 2.16-4.26).

INTERPRETATION

Prepregnancy surgery is associated with the risk of neonatal abstinence syndrome in future pregnancies. Prescription opioids for postsurgical pain may result in opioid use disorders during future pregnancies, inadvertently increasing the risk of neonatal abstinence syndrome in offspring.

摘要

背景

新生儿戒断综合征的发病率日益增高，可能与术后开具的疼痛控制类阿片药物处方导致的药物使用障碍有关。我们评估了产妇孕前手术与未来妊娠中因阿片类药物使用障碍导致的新生儿戒断综合征风险之间的关联。

方法

我们对加拿大魁北克省 1989 年至 2016 年间的 2182365 例分娩进行了一项纵向回顾性队列研究。主要暴露因素为产妇孕前手术。主要结局指标为新生儿戒断综合征。我们使用对数二项式回归模型，根据母体合并症和妊娠特征对关联进行调整。

结果

队列中新生儿戒断综合征的患病率为每 10000 例活产中有 10.7 例。与无手术相比，孕前手术与新生儿戒断综合征的风险比（RR）为 1.63（95%置信区间[CI]为 1.49-1.78）。3 次或更多次孕前手术（RR 2.34，95%CI 2.07-2.63）和首次手术时年龄<15 岁（1 次手术：RR 2.08，95%CI 1.71-2.54；2 次或更多次手术：RR 2.79，95%CI 2.32-3.37）的风险更高。几乎所有手术科室均增加了新生儿戒断综合征的风险，但心胸外科（RR 4.45，95%CI 2.87-6.91）、神经外科（RR 3.00，95%CI 1.56-5.77）和泌尿科手术（RR 3.03，95%CI 2.16-4.26）的相关性最强。