Department of Pediatrics, Boston Medical Center, Boston, MA, USA; Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA.
Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, USA; Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, USA.
Clin Ther. 2019 Sep;41(9):1681-1689. doi: 10.1016/j.clinthera.2019.07.003. Epub 2019 Jul 27.
The use of the opioid antagonist naltrexone (NTX) for pregnant women with opioid use disorder (OUD) remains understudied. The purpose of this pilot study was to examine pregnancy and neonatal outcomes in a cohort of NTX-treated women.
This single-center, retrospective cohort study included 6 mother-infant dyads taking NTX compared with 13 taking buprenorphine (BUP) between 2017 and 2019. Maternal demographic characteristics, any unprescribed or illicit opioid use per urine toxicology or provider report during the pregnancy or 6 months' postdelivery, delivery outcomes, gestational age, birth weight, Apgar scores, neonatal intensive care unit admission, and neonatal abstinence syndrome (NAS) outcomes (NAS diagnosis, pharmacologic treatment, and total hospital length of stay) were compared.
Maternal and infant demographic characteristics were similar between the 2 groups, with the exception of cigarette smoking in the BUP group being more common (92% vs 33%; P = 0.02). None of the women on NTX versus 23% of the women on BUP had documented opioid misuse (P = 0.52). No infants in the NTX group had a NAS diagnosis versus 92% in the BUP group (P < 0.001). Forty-six percent of the BUP-exposed infants were treated for NAS versus 0% in the NTX group (P < 0.001). NTX-exposed infants had a shorter length of stay (mean [SD], 3.2 [1.6] vs 10.9 [8.2] days; P = 0.008).
Maintaining women on NTX during pregnancy was associated with favorable outcomes. These results support the need for larger multicenter studies sufficiently powered to detect possible differences between the medications on long-term maternal and child safety and efficacy outcomes.
在患有阿片类药物使用障碍（OUD）的孕妇中使用阿片类拮抗剂纳曲酮（NTX）的研究仍然不足。本研究的目的是研究一组接受 NTX 治疗的女性的妊娠和新生儿结局。
这项单中心回顾性队列研究纳入了 6 对接受 NTX 治疗的母婴对，并与 2017 年至 2019 年期间接受丁丙诺啡（BUP）治疗的 13 对母婴进行了比较。比较了母亲的人口统计学特征、尿液毒物检测或提供者报告的任何未经处方或非法阿片类药物使用情况、分娩结局、胎龄、出生体重、阿普加评分、新生儿重症监护病房入院率以及新生儿戒断综合征（NAS）结局（NAS 诊断、药物治疗和总住院时间）。
两组患者的母亲和婴儿人口统计学特征相似，除了 BUP 组更常见吸烟（92%比 33%；P=0.02）外。与接受 BUP 的女性相比，接受 NTX 的女性中没有记录到药物滥用的（52%）。接受 NTX 的女性中没有婴儿被诊断为 NAS，而接受 BUP 的女性中则有 92%（P<0.001）。暴露于 BUP 的婴儿中有 46%接受了 NAS 治疗，而 NTX 组中则为 0%（P<0.001）。暴露于 NTX 的婴儿住院时间较短（平均[标准差]，3.2[1.6]天比 10.9[8.2]天；P=0.008）。
在怀孕期间维持女性使用 NTX 与良好的结局相关。这些结果支持需要进行更大规模的多中心研究，以充分检测这两种药物在长期母婴安全性和疗效结局方面的可能差异。
