Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
Am J Obstet Gynecol. 2024 Sep;231(3):356.e1-356.e15. doi: 10.1016/j.ajog.2024.05.033. Epub 2024 May 22.
BACKGROUND: Although methamphetamine use has been increasing in recent years and occurring within new populations and in broader geographical areas, there is limited research on its use and effect in pregnancy. OBJECTIVE: This study aimed to examine the association between prenatal methamphetamine use and maternal and neonatal outcomes in a large, contemporary birth cohort. STUDY DESIGN: This was a retrospective cohort study using California-linked vital statistics and hospital discharge data from 2008 to 2019. Methamphetamine use was identified using the International Classification of Disease, Ninth Revision and Tenth Revision, codes. Chi-square tests and multivariable Poisson regression models were used to evaluate the associations between methamphetamine use and maternal and neonatal outcomes. RESULTS: A total of 4,775,463 pregnancies met the inclusion criteria, of which 18,473 (0.39%) had methamphetamine use. Compared with individuals without methamphetamine use, individuals with methamphetamine use had an increased risk of nonsevere hypertensive disorders (adjusted risk ratio, 1.81; 95% confidence interval, 1.71-1.90), preeclampsia with severe features (adjusted risk ratio, 3.38; 95% confidence interval, 3.14-3.63), placental abruption (adjusted risk ratio, 3.77; 95% confidence interval, 3.51-4.05), cardiovascular morbidity (adjusted risk ratio, 4.30; 95% confidence interval, 3.79-4.88), and severe maternal morbidity (adjusted risk ratio, 3.53; 95% confidence interval, 3.29-3.77). In addition, adverse neonatal outcomes were increased, including preterm birth at <37 weeks of gestation (adjusted risk ratio, 2.85; 95% confidence interval, 2.77-2.94), neonatal intensive care unit admission (adjusted risk ratio, 2.46; 95% confidence interval, 2.39-2.53), and infant death (adjusted risk ratio, 2.73; 95% confidence interval, 2.35-3.16). CONCLUSION: Methamphetamine use in pregnancy is associated with an increased risk of adverse maternal and neonatal outcomes that persists after adjustment for confounding variables and sociodemographic factors. Our results can inform prenatal and postpartum care for this high-risk, socioeconomically vulnerable population.
背景：近年来，冰毒的使用呈上升趋势，且发生在新人群和更广泛的地理区域，但其在妊娠期间的使用和影响的研究有限。
目的：本研究旨在考察一个大型当代出生队列中产前使用冰毒与母婴结局之间的关联。
研究设计：这是一项回顾性队列研究，使用了 2008 年至 2019 年加州关联的生命统计数据和医院出院数据。使用国际疾病分类第 9 版和第 10 版代码来识别冰毒的使用情况。采用卡方检验和多变量泊松回归模型来评估冰毒使用与母婴结局之间的关联。
结果：共有 4775463 例妊娠符合纳入标准，其中 18473 例（0.39%）有冰毒使用。与未使用冰毒者相比，使用冰毒者发生非重度高血压疾病的风险增加（调整风险比，1.81；95%置信区间，1.71-1.90）、有严重特征的子痫前期（调整风险比，3.38；95%置信区间，3.14-3.63）、胎盘早剥（调整风险比，3.77；95%置信区间，3.51-4.05）、心血管发病率（调整风险比，4.30；95%置信区间，3.79-4.88）和严重产妇发病率（调整风险比，3.53；95%置信区间，3.29-3.77）。此外，不良新生儿结局增加，包括早产（<37 孕周）（调整风险比，2.85；95%置信区间，2.77-2.94）、新生儿重症监护病房（NICU）入住（调整风险比，2.46；95%置信区间，2.39-2.53）和婴儿死亡（调整风险比，2.73；95%置信区间，2.35-3.16）。
结论：在妊娠期间使用冰毒与不良母婴结局的风险增加有关，这种风险在调整混杂变量和社会人口因素后仍然存在。我们的研究结果可以为这一高风险、社会经济脆弱人群提供产前和产后护理信息。
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