DeLisle Alexa, Jones Hendrée E, Jansson Lauren M
From the UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC (AD); UNC Horizons Program, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC; Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD (HEJ); and Center for Addiction and Pregnancy, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD (LMJ).
J Addict Med. 2023;17(2):123-125. doi: 10.1097/ADM.0000000000001065. Epub 2022 Sep 6.
Gabapentin is a γ-aminobutyric acid analog formally indicated for the treatment of epilepsy and neuropathic pain that is gaining increased popularity. Gabapentin has been historically considered a safe medication, including during pregnancy and lactation, with low reported concerns for misuse and use disorders. However, new empirical efforts are revealing concerns regarding the safety of widespread gabapentin use, particularly in pregnancy and for individuals with a propensity toward substance misuse. The Food and Drug Administration's full prescribing information report on gabapentin provides concerning preclinical data and then states that gabapentin is potentially "developmentally toxic" and has an unknown risk of birth impacts. Concerns have also been raised surrounding in utero exposure to gabapentin due to the onset and presentation of atypical and/or difficult to control withdrawal signs and symptoms in neonates, including those dually exposed to opioids, as well as neonatal exposure to gabapentin via breastmilk. Moreover, nonprescribed gabapentin use has become an increasing problem, with opioid use disorder being the greatest risk factor for such misuse. This article summarizes the current literature regarding gabapentin use during pregnancy and related prenatal and neonatal exposure outcomes with special consideration for interactions between gabapentin and opioid use. Taken together, the current literature suggests that gabapentin use should be considered with caution during pregnancy and during the post-partum period. Well-controlled, prospective research studies are needed to determine the extent of the risks and benefits of prescribed and nonprescribed gabapentin exposure to pregnant people and their neonates.
加巴喷丁是一种γ-氨基丁酸类似物，正式用于治疗癫痫和神经性疼痛，且越来越受欢迎。加巴喷丁历来被认为是一种安全的药物，包括在妊娠和哺乳期，关于其滥用和使用障碍的报道担忧较少。然而，新的实证研究揭示了对广泛使用加巴喷丁安全性的担忧，特别是在妊娠期间以及对有药物滥用倾向的个体。美国食品药品监督管理局关于加巴喷丁的完整处方信息报告提供了令人担忧的临床前数据，然后指出加巴喷丁可能具有“发育毒性”，且对出生的影响风险未知。由于新生儿出现非典型和/或难以控制的戒断体征和症状，包括那些同时接触阿片类药物的新生儿，以及新生儿通过母乳接触加巴喷丁，子宫内接触加巴喷丁也引发了担忧。此外，非处方使用加巴喷丁已成为一个日益严重的问题，阿片类药物使用障碍是此类滥用的最大风险因素。本文总结了当前关于妊娠期间使用加巴喷丁以及相关产前和新生儿暴露结果的文献，特别考虑了加巴喷丁与阿片类药物使用之间的相互作用。综合来看，当前文献表明，在妊娠期间和产后期间应谨慎考虑使用加巴喷丁。需要进行严格控制的前瞻性研究，以确定处方和非处方加巴喷丁暴露于孕妇及其新生儿的风险和益处程度。
