Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper).
Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, and Casey, Ms Blanchard, and Drs Tita and Harper); Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL (Drs Robbins, Perez, Casey, Tita, and Harper).
Am J Obstet Gynecol MFM. 2021 Jul;3(4):100372. doi: 10.1016/j.ajogmf.2021.100372. Epub 2021 Apr 6.
There are concerns regarding neurobehavioral changes in infants exposed to parenteral opioids during labor; however, long-term neurodevelopment remains unstudied.
We aimed to examine the association between parenteral opioids used as labor analgesia and perinatal outcomes and childhood neurodevelopment until 2 years of age among infants born prematurely. We hypothesized that intrapartum exposure to parenteral opioids is associated with impaired neurodevelopment and adverse perinatal outcomes.
This was a secondary analysis of a multicenter, randomized controlled trial assessing magnesium for the prevention of cerebral palsy in infants at risk for preterm birth. Women delivering a singleton, nonanomalous, live infant before 37 weeks' gestation were considered for inclusion. Women were excluded if they had missing exposure or primary outcome data, were exposed to general anesthesia, or reported use of heroin or unspecified illicit drugs. Women reporting use of nonopioid illicit drugs such as cocaine and marijuana were not excluded. Groups were compared based on exposure or nonexposure to parenteral opioids (intravenous or intramuscular) used as labor analgesia. The primary outcome was any psychomotor or mental developmental delay at 24 months according to the Bayley Scales of Infant Development II. Secondary outcomes were the Bayley Scales of Infant Development II subdomains and adverse perinatal outcomes. Multivariable logistic regression models were performed and adjusted odds ratios with 95% confidence intervals were estimated.
Of the 1404 women included, 535 (38%) received parenteral opioids as labor analgesia. Women receiving parenteral opioids were more likely to be younger, Hispanic, and present with cervical dilation ≥4 cm. Parenteral opioid recipients had lower rates of illicit nonopioid drug or tobacco use, a lower rate of cesarean delivery, lower educational level and were less likely to be undergoing induction. Women receiving parenteral opioids who underwent cesarean delivery were less likely to do so because of a nonreassuring fetal status. In the unadjusted and adjusted analyses, there were no significant differences in the primary outcomes of psychomotor or mental developmental delay at 2 years of age (adjusted odds ratio, 0.96; confidence interval, 0.76-1.20). The only significant difference in secondary outcomes was a shorter O requirement duration in the parenteral opioid group (2 vs 4 days; P=.002).
Among a population of preterm infants vulnerable to neurologic impairment, intrapartum exposure to parenteral opioids was not associated with an increased risk for neurodevelopmental delay up to 2 years of age, nor did these infants have worse perinatal outcomes.
人们对分娩过程中接受肠外阿片类药物的婴儿出现神经行为变化表示担忧，但长期神经发育仍未得到研究。
我们旨在研究在接受产前镇痛的肠外阿片类药物的早产儿中，肠外阿片类药物的使用与围产期结局和儿童神经发育之间的关系，直到 2 岁。我们假设分娩过程中接触肠外阿片类药物与神经发育受损和不良围产期结局有关。
这是一项多中心、随机对照试验的二次分析，该试验评估了镁在预防有早产风险的婴儿脑瘫中的作用。考虑纳入在 37 周妊娠前分娩单胎、非畸形、活产婴儿的女性。如果女性缺少暴露或主要结局数据、接受全身麻醉或报告使用海洛因或未指明的非法药物，则将其排除在外。未将报告使用可卡因和大麻等非阿片类非法药物的女性排除在外。根据是否接受静脉或肌肉内阿片类药物（作为分娩镇痛）进行分组比较。主要结局是根据贝利婴幼儿发展量表 II 评估的 24 个月时任何精神运动或智力发育迟缓。次要结局是贝利婴幼儿发展量表 II 亚域和不良围产期结局。进行了多变量逻辑回归模型，并估计了 95%置信区间的调整比值比。
在纳入的 1404 名女性中，535 名（38%）接受了肠外阿片类药物作为分娩镇痛。接受肠外阿片类药物的女性更年轻、西班牙裔、宫口扩张≥4cm。肠外阿片类药物使用者使用非法非阿片类药物或烟草的比例较低，剖宫产率较低，教育程度较低，且不太可能接受引产。接受肠外阿片类药物且行剖宫产的女性较少因胎儿状态不稳定而进行剖宫产。在未调整和调整分析中，2 岁时精神运动或智力发育迟缓的主要结局无显著差异（调整比值比，0.96；95%置信区间，0.76-1.20）。次要结局中唯一显著的差异是肠外阿片类药物组的 O 需求持续时间较短（2 天与 4 天；P=0.002）。
在有神经损伤风险的早产儿人群中，分娩过程中接触肠外阿片类药物与 2 岁时神经发育延迟的风险增加无关，这些婴儿的围产期结局也没有恶化。
