Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey).
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Sanusi, Gray, Szychowski, Brocato, Casey, and Sinkey).
Am J Obstet Gynecol MFM. 2022 Nov;4(6):100719. doi: 10.1016/j.ajogmf.2022.100719. Epub 2022 Aug 15.
The prevalence of opioid use disorder and medication-assisted treatment in pregnancy is increasing. Compared with term infants, preterm infants have a lower incidence of neonatal opioid withdrawal syndrome. It is unknown whether early term delivery compared with full or late-term delivery decreases the risk of neonatal opioid withdrawal syndrome.
This study aimed to compare the neonatal outcomes among opioid-exposed infants born in the early, full, and late-term periods.
This was a retrospective cohort study of opioid-exposed pregnancies delivering at a single center from 2010 to 2017 at ≥37 weeks gestation. Participants with multiple gestations or fetal anomalies were excluded. Maternal opioid exposure was defined as prescription (including medication-assisted treatment) or nonprescription opioid use or a positive urine drug screen in pregnancy for opiates. The primary outcome was a neonatal composite of respiratory distress syndrome, neonatal sepsis, neonatal seizures, hypoxic ischemic encephalopathy, jaundice requiring treatment, 5-minute Apgar <5, neonatal intensive care unit admission, neonatal opioid withdrawal syndrome, or neonatal death. The secondary outcomes included individual components of the primary outcome, birthweight, need for and length of neonatal opioid withdrawal syndrome treatment, length of hospital admission, and maximum Finnegan scores. Early (37-<39), full (39-<41), and late (41-<42 weeks) term groups were defined by the American College of Obstetricians and Gynecologists.
Of 399 infants, 136 (34.1%), 229 (57.4%), and 34 (8.5%) were born in the early, full, and late-term periods, respectively. Two hundred and seventy patients (67.7%) received medication-assisted treatment for opioid use disorder, and the baseline characteristics were similar in all the groups except for history of intranasal heroin use, positive urine toxicology screen for heroin or any opiates, and delivery indication (P<.05). The primary composite outcome occurred in 313 (78.4%) neonates, and 296 (74.2%) neonates had neonatal opioid withdrawal syndrome. More than half (219 [54.9%]) of opioid-exposed neonates were admitted to the neonatal intensive care unit, and 160 (40.1%) required pharmacologic neonatal opioid withdrawal syndrome treatment for a mean duration of almost 3 weeks (19.0±16.1 days). There were no significant differences in the primary composite outcome, incidence of neonatal opioid withdrawal syndrome, or other secondary outcomes (except birthweight) between neonates born in the early, full, or late-term periods.
Although neonatal morbidity was frequent among opioid-exposed neonates, the incidence and severity of neonatal opioid withdrawal syndrome or other neonatal outcomes were not different between neonates delivered in the early, full, and late-term periods, suggesting that opioid-exposed infants may not benefit from early term delivery.
阿片类药物使用障碍和药物辅助治疗在妊娠中的患病率正在增加。与足月婴儿相比，早产儿患有新生儿阿片类戒断综合征的发病率较低。与足月或晚期分娩相比，早期分娩是否会降低新生儿阿片类戒断综合征的风险尚不清楚。
本研究旨在比较在 37 周以上分娩的阿片类药物暴露婴儿中，早期、足月和晚期分娩的新生儿结局。
这是一项回顾性队列研究，纳入了 2010 年至 2017 年在一家单中心分娩的≥37 周孕期的阿片类药物暴露妊娠。排除多胎妊娠或胎儿畸形的参与者。母亲阿片类药物暴露定义为处方（包括药物辅助治疗）或非处方阿片类药物使用，或妊娠期间阿片类药物尿液药物检测呈阳性。主要结局是呼吸窘迫综合征、新生儿败血症、新生儿癫痫发作、缺氧缺血性脑病、需要治疗的黄疸、5 分钟 Apgar 评分<5、新生儿重症监护病房入院、新生儿阿片类戒断综合征或新生儿死亡的新生儿复合症。次要结局包括主要结局的各个组成部分、出生体重、新生儿阿片类戒断综合征治疗的需要和时间、住院时间和最大芬尼根评分。早期（37-<39 周）、足月（39-<41 周）和晚期（41-<42 周）分别由美国妇产科医师学会定义。
在 399 名婴儿中，136 名（34.1%）、229 名（57.4%）和 34 名（8.5%）分别出生于早期、足月和晚期。270 名患者（67.7%）接受了阿片类药物使用障碍的药物辅助治疗，除了经鼻海洛因使用史、阿片类药物或任何阿片类药物尿液毒物筛查阳性和分娩指征外（P<.05），所有组的基线特征均相似。主要复合结局发生在 313 名（78.4%）新生儿中，296 名（74.2%）新生儿出现新生儿阿片类戒断综合征。超过一半（219 [54.9%]）的阿片类药物暴露新生儿被收治入新生儿重症监护病房，160 名（40.1%）需要进行药物治疗以缓解新生儿阿片类戒断综合征，平均持续时间近 3 周（19.0±16.1 天）。在早期、足月和晚期分娩的新生儿中，主要复合结局、新生儿阿片类戒断综合征的发生率或其他次要结局（除出生体重外）均无显著差异。
尽管阿片类药物暴露的新生儿发病率较高，但新生儿阿片类戒断综合征或其他新生儿结局的发生率和严重程度在早期、足月和晚期分娩的新生儿中并无差异，这表明阿片类药物暴露的婴儿可能不会从早期分娩中获益。
