孕期使用对乙酰氨基酚：在一个前瞻性的出生队列中检查使用的流行率、时间和指征。
Acetaminophen use in pregnancy: Examining prevalence, timing, and indication of use in a prospective birth cohort.
机构信息
Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA.
出版信息
Paediatr Perinat Epidemiol. 2020 May;34(3):237-246. doi: 10.1111/ppe.12595. Epub 2019 Nov 7.
BACKGROUND
Previous studies of prenatal acetaminophen use have not addressed what indications and maternal co-factors describe acetaminophen use.
OBJECTIVE
The objective of this study was to describe these parameters in a well-characterised, prospective birth cohort.
METHODS
Data were drawn from the MotherToBaby study of pregnant women enrolled from 2004 to 2018. Daily acetaminophen diaries were calculated for all exposed women with complete dose and duration information. Descriptive statistics were used to assess maternal characteristics associated with acetaminophen use. Prevalence by 2-year interval was described, and linear regression was used to test for trend. Indication of use and dose per indication were summarised.
RESULTS
Of 2441 subjects, 1515 (62%) reported use of acetaminophen. Over the 15-year period, there was a decline in use of 2.5% for each 2-year period (test for trend = 0.001) with 58% reporting acetaminophen use in 2017-2018. Among women with acetaminophen use in pregnancy (n = 1515), 58% reported <10 days of use, 13% reported 10-19 days of use, 9% reported 20-44 days of use, and 9% reported 45 or more days of use. Twelve per cent had undefined duration of use. Increasing duration of exposure was associated with tobacco use, obesity, self-reported depression or anxiety, and antidepressant use. The most frequently reported indication was headache, however, indication varied by duration of use, with more women reporting use for sleep or pain/injury in the categories with the longest duration of use. Median dose per exposed day was highest among those reporting use for sleep, and higher doses were more frequently reported for arthritis, injury, and pain.
CONCLUSION
Acetaminophen is used by the majority of pregnant women, and some continue to use for many weeks in pregnancy. Given the heterogeneity in duration of use, indication, and dose, studies that estimate the risk of adverse outcomes associated with acetaminophen must carefully consider these factors.
背景
之前关于产前使用对乙酰氨基酚的研究并未涉及哪些适应症和母体伴随因素描述了对乙酰氨基酚的使用情况。
目的
本研究的目的是在一个特征良好的前瞻性出生队列中描述这些参数。
方法
数据来自于 2004 年至 2018 年招募的母亲宝贝研究中的孕妇。对于所有暴露于药物且具有完整剂量和持续时间信息的女性，计算了每日对乙酰氨基酚日记。使用描述性统计数据评估了与对乙酰氨基酚使用相关的母体特征。按 2 年间隔描述了流行率，并使用线性回归测试了趋势。总结了使用的适应症和每个适应症的剂量。
结果
在 2441 名受试者中，有 1515 名（62%）报告使用了对乙酰氨基酚。在 15 年期间，每 2 年期间的使用量下降了 2.5%（趋势检验=0.001），2017-2018 年有 58%的女性报告使用了对乙酰氨基酚。在怀孕期间使用对乙酰氨基酚的女性（n=1515）中，有 58%的人报告使用了<10 天，13%的人报告使用了 10-19 天，9%的人报告使用了 20-44 天，9%的人报告使用了 45 天或更长时间。有 12%的人没有报告使用时间的具体长度。暴露时间的增加与吸烟、肥胖、自我报告的抑郁或焦虑以及使用抗抑郁药有关。报告最多的适应症是头痛，但随着使用时间的延长，适应症也有所不同，在使用时间最长的类别中，更多的女性报告使用对乙酰氨基酚来治疗睡眠或疼痛/受伤。在报告用于睡眠的人群中，每暴露日的中位数剂量最高，而更高的剂量更频繁地报告用于关节炎、受伤和疼痛。
结论
大多数孕妇使用对乙酰氨基酚，有些孕妇在怀孕期间会持续使用数周。鉴于使用时间、适应症和剂量的异质性，估计与对乙酰氨基酚相关的不良结局的研究必须仔细考虑这些因素。
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