Kaleida Health Oishei Children's Hospital, Buffalo, NY.
Department of Obstetrics & Gynecology, University of North Carolina, Raleigh, NC.
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100179. doi: 10.1016/j.ajogmf.2020.100179. Epub 2020 Jul 3.
The goal of this systematic review and metaanalysis is to compare pregnancy outcomes between pregnant women undergoing treatment for opioid use disorder with buprenorphine-naloxone and those undergoing treatment for opioid use disorder with other forms of medication-assisted treatment.
PubMed, Embase, PsycINFO, Cochrane Clinical Trials, and Web of Science were searched to identify studies assessing the relationship between maternal buprenorphine-naloxone use and pregnancy outcomes. Outcomes assessed included neonatal abstinence syndrome diagnosis and treatment, neonatal intensive care unit admission, length of neonatal hospital stay, delivery complications, mode of delivery, labor analgesia, illicit drug use, medication-assisted treatment dosage, gestational age at delivery, breastfeeding status, miscarriage, congenital anomalies, intrauterine fetal demise, birthweight, head circumference, length, and Apgar scores.
Overall, 5 studies comprising 6 study groups met the inclusion criteria. Of the 1875 mother-baby dyads available for analysis, medications prescribed as part of the medication-assisted treatment included buprenorphine-naloxone, buprenorphine alone, methadone, or long-acting opioids. There were no serious adverse maternal or neonatal outcomes associated with maternal buprenorphine-naloxone use reported among any of the studies. Women prescribed with buprenorphine-naloxone for delivered neonates who were less likely to require treatment for neonatal abstinence syndrome were compared with pregnant women prescribed with other opioid agonist medications. Of the remaining outcomes assessed, metaanalysis did not detect any statistically significant differences when comparing the groups of women using buprenorphine-naloxone with the groups of women prescribed with other medications as part of the medication-assisted treatment.
Pregnant women undergoing treatment for opioid use disorder with buprenorphine-naloxone do not experience significantly different pregnancy outcomes than women undergoing treatment with other forms of opioid agonist medication-assisted therapy.
本系统评价和荟萃分析的目的是比较使用丁丙诺啡-纳洛酮和其他形式药物辅助治疗治疗阿片类药物使用障碍的孕妇的妊娠结局。
检索了 PubMed、Embase、PsycINFO、Cochrane 临床试验和 Web of Science，以确定评估母亲使用丁丙诺啡-纳洛酮与妊娠结局之间关系的研究。评估的结果包括新生儿戒断综合征的诊断和治疗、新生儿重症监护病房入院、新生儿住院时间、分娩并发症、分娩方式、分娩镇痛、非法药物使用、药物辅助治疗剂量、分娩时的胎龄、母乳喂养状况、流产、先天性异常、宫内胎儿死亡、出生体重、头围、长度和阿普加评分。
共有 5 项研究符合纳入标准，共包含 6 个研究组。在 1875 对可供分析的母婴对中，作为药物辅助治疗一部分开出的药物包括丁丙诺啡-纳洛酮、丁丙诺啡、美沙酮或长效阿片类药物。在任何研究中，都没有报告与母亲使用丁丙诺啡-纳洛酮相关的严重不良母婴或新生儿结局。与接受其他阿片类激动剂药物治疗的孕妇相比，接受丁丙诺啡-纳洛酮治疗的分娩新生儿不太可能需要接受新生儿戒断综合征治疗的女性。在评估的其余结果中，当比较使用丁丙诺啡-纳洛酮的女性组与作为药物辅助治疗一部分开出其他药物的女性组时，荟萃分析没有发现任何统计学上显著的差异。
接受丁丙诺啡-纳洛酮治疗阿片类药物使用障碍的孕妇与接受其他形式阿片类激动剂药物辅助治疗的孕妇相比，妊娠结局没有明显差异。
