在产前暴露于阿片类药物维持治疗的儿童的神经发育结果:基于人口的研究
Mennatullah Hasan1, Kimford J Meador2, Todd N Brothers1
1Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA.
Pharmacotherapy
|October 17, 2024
概括
怀孕期间产前接触甲与儿童神经发育障碍 (NDD) 的更高风险有关. 布普伦诺芬暴露对长期神经发育的影响很小,这表明它是孕妇阿片类药物使用障碍 (OUD) 的有利治疗选择.
科学领域:
- 围产期健康 围产期健康
- 神经发育障碍 神经发育障碍
- 药理干预措施 药理干预
背景情况:
- 使用美沙或布普伦诺芬的阿片类药物维持治疗 (OMT) 对于在孕妇中管理阿片类药物使用障碍 (OUD) 至关重要.
- 虽然布普伦诺啡显示出更好的短期结果,但其对儿童神经发育的长期影响不太清楚.
研究的目的:
- 调查产前阿片类药物维持治疗 (OMT) 对儿童神经发育障碍 (NDD) 发生率的长期影响.
- 检查妊娠期间OMT定时对NDD风险的影响.
主要方法:
- 使用罗德岛医疗补助数据 (2008-2018) 的回顾性队列研究.
- 包括OUD诊断的怀孕和持续的医疗补助覆盖范围.
- 暴露量定义为布普伦诺芬或美沙的发放/索赔,按早期 (0-90天) 或晚期 (>90天) 怀孕分类.
- 使用经过验证的算法确定了NDD; 应用了Cox比例危险模型与倾向性得分重叠权重.
主要成果:
- 与早期布普伦诺芬暴露相比,在怀孕早期暴露于美沙的儿童患NDD的风险明显更高 (aHR:2.75).
- 与晚期布普伦诺芬暴露相比,晚期甲暴露也与NDD风险增加有关 (aHR:2.05).
- 在怀孕早期和晚期都暴露于美沙,与未暴露组相比,NDD发病率更高.
结论:
- 布普伦诺芬似乎是怀孕期间更安全的OMT选择,与儿童的长期神经发育风险较少有关.
- 需要进一步的研究来证实这些发现,并解决潜在的混因素.
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