Hull Ilana, Jawa Raagini, Shang Margaret, Davis Corey, King Cambria, McMurtrie Gary, Krans Elizabeth
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
J Addict Dis. 2024 Aug 21:1-8. doi: 10.1080/10550887.2024.2391156.
The rise in pregnancy-related overdose deaths has been driven by the use of high-potency illicitly-manufactured synthetic opioids including fentanyl. Xylazine, a veterinary sedative, is increasingly noted as a common adulterant in the United States illicit opioid supply. Exposure to the xylazine-fentanyl combination has been associated with severe harms including sedation, necrotic wounds, and symptoms of xylazine withdrawal. Due to limited data that directly addresses the risks of xylazine exposure during human pregnancy, we conducted a narrative review to summarize the available evidence about the clinical implications of xylazine exposure in pregnancy drawing from evidence from animal models, the general adult population, and the authors' clinical experiences. Because xylazine exposure presents unique risks to pregnant persons, management of xylazine exposure and related clinical sequelae in pregnant persons warrants nuanced clinical management. Further, additional research is critically needed to develop best practice guidelines related to the management of co-occurring xylazine-opioid exposure during pregnancy including harm reduction strategies to reduce exposure risk during pregnancy.
与妊娠相关的过量用药死亡人数增加是由使用包括芬太尼在内的高效非法制造的合成阿片类药物所致。甲苯噻嗪是一种兽用镇静剂，在美国非法阿片类药物供应中越来越多地被用作常见的掺杂物。接触甲苯噻嗪-芬太尼组合与严重危害有关，包括镇静、坏死性伤口和甲苯噻嗪戒断症状。由于直接涉及人类妊娠期间接触甲苯噻嗪风险的数据有限，我们进行了一项叙述性综述，以总结从动物模型、一般成年人群和作者临床经验中获取的关于妊娠期间接触甲苯噻嗪的临床意义的现有证据。由于接触甲苯噻嗪给孕妇带来独特风险，因此对孕妇接触甲苯噻嗪及相关临床后遗症的管理需要细致入微的临床处理。此外，迫切需要开展更多研究，以制定与妊娠期间同时接触甲苯噻嗪-阿片类药物的管理相关的最佳实践指南，包括减少危害策略，以降低妊娠期间的接触风险。
