Hulse G K, Milne E, English D R, Holman C D
Faculty of Medicine and Dentistry, University of Western Australia, Australia.
Addiction. 1997 Nov;92(11):1571-9.
AIMS/DESIGN: Reduction in mean birth weight and increased incidence of low birth weight are both associated with exposure to illicit heroin in pregnancy. Many studies examining neonatal outcomes in pregnant heroin users treated with methadone report improvements in birth weight. As a consequence, methadone treatment has become the 'gold standard' for the management of the pregnant heroin user. However, not all studies report significant birth weight increases associated with methadone. We undertook a number of meta-analyses on reduction in mean birth weight and incidence of low birth weight to estimate more precisely the effect of illicit heroin and methadone.
Results showed mean reduction in birth weight associated with heroin use: 489 g (95% CI 284-693 g), compared with methadone: 279 g (229-328 g). Similarly, the pooled relative risk estimate for low birth weight for maternal heroin use was 4.61 (95% CI 2.78-7.65), compared with 1.36 (0.83-2.22) for methadone. Analysis of data on combined heroin and methadone use produced a pooled mean reduction in birth weight of 557 g (403-710 g), with a pooled relative risk estimate for low birth weight of 3.28 (2.47-4.39). Pooling 'any' methadone data, regardless of heroin use, produced an estimated reduction in birth weight of 395 g (311-478 g) and a relative risk estimate for low birth weight of 1.90 (1.29-2.81). Combining all data in an 'any' opiate use analysis also produced a mean reduction in birth weight of 483 g (386-583 g) and a relative risk estimate for low birth weight of 3.81 (2.57-5.65).
The current findings suggest that heroin use while receiving methadone may counteract the birth weight advantage gained from methadone alone. Whether this is due to fetal exposure to heroin plus methadone, to reduced antenatal care, other behavioural and environmental factors associated with concurrent use of heroin and methadone or a combination of these is unclear. Nevertheless, these results challenge the current belief that the pregnant user is always better off receiving methadone than not, and suggests that methadone may not be the appropriate treatment for the pregnant women who continue to use illicit heroin.
目的/设计：平均出生体重降低和低出生体重发生率增加均与孕期暴露于非法海洛因有关。许多研究调查了接受美沙酮治疗的孕期海洛因使用者的新生儿结局，报告称出生体重有所改善。因此，美沙酮治疗已成为孕期海洛因使用者管理的“金标准”。然而，并非所有研究都报告美沙酮与出生体重显著增加有关。我们对平均出生体重降低和低出生体重发生率进行了多项荟萃分析，以更准确地估计非法海洛因和美沙酮的影响。
结果显示，与使用海洛因相关的出生体重平均降低：489克（95%置信区间284 - 693克），而美沙酮为：279克（229 - 328克）。同样，母亲使用海洛因导致低出生体重的合并相对风险估计值为4.61（95%置信区间2.78 - 7.65），美沙酮则为1.36（0.83 - 2.22）。对海洛因和美沙酮联合使用的数据进行分析，得出出生体重合并平均降低557克（403 - 710克），低出生体重合并相对风险估计值为3.28（2.47 - 4.39）。汇总“任何”美沙酮数据，无论是否使用海洛因，估计出生体重降低395克（311 - 478克），低出生体重相对风险估计值为1.90（1.29 - 2.81）。在“任何”阿片类药物使用分析中合并所有数据，也得出出生体重平均降低483克（386 - 583克），低出生体重相对风险估计值为3.81（2.57 - 5.65）。
目前的研究结果表明，在接受美沙酮治疗时使用海洛因可能会抵消仅使用美沙酮所获得的出生体重优势。这是由于胎儿暴露于海洛因加美沙酮、产前护理减少、与海洛因和美沙酮同时使用相关的其他行为和环境因素，还是这些因素的综合作用尚不清楚。然而，这些结果挑战了当前认为孕期使用者接受美沙酮治疗总是比不接受更好的观念，并表明美沙酮可能不是继续使用非法海洛因的孕妇的合适治疗方法。
