Anyaegbunam A, Tran T, Jadali D, Randolph G, Mikhail M S
Department of Obstetrics and Gynecology, Albert Einstein, College of Medicine, Bronx, New York, NY, USA.
Gynecol Obstet Invest. 1997;43(1):25-8. doi: 10.1159/000291812.
To investigate parameters of fetal well-being (characteristics of nonstress test, NST, and antepartum fetal heart rate, FHR, patterns) and selected neonatal outcomes in pregnant women on methadone maintenance.
A matched case-control study of methadone-treated women receiving prenatal and intrapartum care at a Bronx municipal hospital during 1992-1994. 102 NSTs obtained from 24 methadone-treated women after 35 weeks of pregnancy were compared to 96 NSTs from a control group (n = 24), matched for maternal age, parity, and gestational age. All NSTs were evaluated for general characteristics including time interval between initiation and achievement of reactive NST (2 accelerations > or = 15 bpm lasting for at least 15 s in a 20-min period), baseline, amplitude of fluctuation, frequency of fluctuation, accelerations and decelerations. The scoring system described by Lyons et al. was used for all NSTs. All nonreactive NSTs were followed with biophysical profile tests.
The frequency of nonreactive NSTs was significantly higher for methadone-maintained women compared to controls (19.6 vs. 4.2%; p < 0.01). The average length of time to achieve reactive NST was significantly (p = 0.0016) longer for the methadone-treated group when compared to controls (35.50 +/- 20.96 vs. 14.85 +/- 9.03 min). The total score (Lyons et al.) was significantly lower (p < 0.0007) for the methadone-treated group compared to controls. Mean birth weight, Apgar scores at 1 and 5 min, meconium, and umbilical cord artery pH were not significantly different for methadone-exposed neonates compared to controls.
Methadone-maintained pregnancies are significantly associated with a higher incidence of nonreactive NSTs, longer intervals to achieve reactive NSTs and lower NST scores compared to controls. This may reflect an altered response in fetal central nervous system neurotransmitters and changes in fetal behavior induced by methadone.
研究接受美沙酮维持治疗的孕妇的胎儿健康参数（无应激试验[nonstress test，NST]特征及产前胎儿心率[fetal heart rate，FHR]模式）以及选定的新生儿结局。
一项配对病例对照研究，研究对象为1992 - 1994年期间在布朗克斯区一家市立医院接受产前和产时护理的美沙酮治疗女性。将24名美沙酮治疗女性在妊娠35周后获得的102次NST与对照组（n = 24）的96次NST进行比较，对照组在产妇年龄、产次和孕周方面进行了匹配。对所有NST评估其一般特征，包括从开始到出现反应性NST（20分钟内有2次加速≥15次/分钟且持续至少15秒）的时间间隔、基线、波动幅度、波动频率、加速和减速情况。所有NST均采用Lyons等人描述的评分系统。所有无反应性NST均采用生物物理评分试验进行随访。
与对照组相比，美沙酮维持治疗的女性无反应性NST的频率显著更高（19.6%对4.2%；p < 0.01）。与对照组相比，美沙酮治疗组达到反应性NST的平均时间显著更长（p = 0.0016）（35.50±20.96分钟对14.85±9.03分钟）。与对照组相比，美沙酮治疗组的总分（Lyons等人）显著更低（p < 0.0007）。与对照组相比，暴露于美沙酮的新生儿的平均出生体重、1分钟和5分钟时的阿氏评分、胎粪及脐动脉pH值无显著差异。
与对照组相比，美沙酮维持治疗的妊娠与无反应性NST的发生率更高、达到反应性NST的间隔时间更长以及NST评分更低显著相关。这可能反映了胎儿中枢神经系统神经递质反应的改变以及美沙酮引起的胎儿行为变化。
