Kinsella Michael, Halliday Lucy O E, Shaw Martin, Capel Yasmin, Nelson Scott M, Kearns Rachel J
School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
NHS Greater Glasgow and Clyde, Glasgow, UK.
Subst Use Misuse. 2022;57(9):1400-1416. doi: 10.1080/10826084.2022.2083174. Epub 2022 Jun 25.
Illicit opioid use in pregnancy is associated with adverse maternal, neonatal, and childhood outcomes. Opioid substitution is recommended, but whether methadone or buprenorphine is the optimal agent remains unclear.
We searched EMBASE, PubMed, Web of Science, Scopus, Open Gray, CINAHL and the Cochrane Central Registry of Controlled Trials (CENTRAL) from inception to April 2020 for randomized controlled trials (RCTs) and cohort studies comparing methadone and buprenorphine treatment for opioid-using mothers. Included studies assessed maternal and or neonatal outcomes. We used random-effects meta-analyses to estimate summary measures for outcomes and report these separately for RCTs and cohort studies.
Of 408 abstracts screened, 20 papers were included (4 RCTs, 16 cohort, 223 and 7028 participants respectively). All RCTs (4/4) had a high risk of bias and median (IQR) Newcastle Ottawa Scale for cohort studies was 7.5 (6-9). In both RCTs and cohort studies, buprenorphine was associated with; greater offspring birth weight (weighted mean difference [WMD] 343 g (95% CI: 40-645 g) in RCT and 184 g (95% CI: 121-247 g) in cohort studies); body length at birth (WMD 2.28 cm (95% CI: 1.06-3.49 cm) in RCTs and 0.65 cm (95% CI: 0.31-0.98 cm) in cohort studies); and reduced risk of prematurity (risk ratio [RR] 0.41 (95% CI: 0.18-0.93) in RCTs and 0.63 [95% CI: 0.53-0.75] in cohort studies) when compared to methadone. All other clinical outcomes were comparable.
Compared to methadone, buprenorphine was consistently associated with improved birthweight and gestational age, however given potential biases, results should be interpreted with caution.
孕期非法使用阿片类药物与不良的孕产妇、新生儿及儿童结局相关。推荐进行阿片类药物替代治疗，但美沙酮和丁丙诺啡哪种是最佳药物仍不明确。
我们检索了EMBASE、PubMed、科学网、Scopus、Open Gray、CINAHL以及Cochrane对照试验中央注册库（CENTRAL），检索时间从建库至2020年4月，以查找比较美沙酮和丁丙诺啡治疗使用阿片类药物母亲的随机对照试验（RCT）和队列研究。纳入的研究评估了孕产妇和/或新生儿结局。我们采用随机效应荟萃分析来估计结局的汇总指标，并分别针对RCT和队列研究报告这些指标。
在筛选的408篇摘要中，纳入了20篇论文（4项RCT、16项队列研究，分别有223名和7028名参与者）。所有RCT（4/4）存在高偏倚风险，队列研究的纽卡斯尔渥太华量表中位数（IQR）为7.5（6 - 9）。在RCT和队列研究中，与美沙酮相比，丁丙诺啡与以下情况相关：后代出生体重增加（RCT中加权平均差[WMD]为343克（95%CI：40 - 645克），队列研究中为184克（95%CI：121 - 247克））；出生时身长（RCT中WMD为2.28厘米（95%CI：1.06 - 3.49厘米），队列研究中为0.65厘米（95%CI：0.31 - 0.98厘米））；早产风险降低（RCT中风险比[RR]为0.41（95%CI：0.18 - 0.93），队列研究中为0.63[95%CI：0.53 - 0.75]）。所有其他临床结局相当。
与美沙酮相比，丁丙诺啡始终与出生体重和孕周改善相关，然而鉴于潜在偏倚，结果应谨慎解读。
