孕期止痛类阿片类药物和与胎盘输血相关的疾病:基于人口的队列研究
Jonathan Brett1,2, Claudia Bruno2, Bianca Varney2
1Faculty of Medicine and Health, St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
International journal of epidemiology
|August 12, 2025
概括
怀孕期间使用止痛药类阿片类药物,特别是可代因和氧可,与胎盘断裂和早产风险的适度增加有关. 这些发现突出了与孕妇阿片类药物处方相关的潜在风险.
科学领域:
- 产科和妇科 产科和妇科
- 临床药理学 临床药理学
- 围产期流行病学 围产期流行病学
背景情况:
- 在怀孕期间使用止痛类阿片类药物可能会增加胎盘输血障碍的风险.
- "阿片类药物使用和不良妊娠结果之间的确切关系需要进一步澄清.
研究的目的:
- 调查母亲使用止痛药阿片类药物与特定妊娠并发症之间的因果关系.
- 分析胎盘断裂,子宫前,早产和胎儿生长限制 (FGR) 的风险.
主要方法:
- 使用澳大利亚新南威尔士州链接健康数据的基于人口的队列研究 (2013年7月 - 2019年12月).
- 定义的阿片类药物暴露,基于从最后一个月经期到出生时的药物发行记录.
- 采用了考克斯的比例危险模型,暴露时间变化,调整为共变量.
主要成果:
- 任何阿片类药物暴露都与胎盘断裂 (aHR 1.22) 和早产 (aHR 1.23) 的风险略有增加有关.
- 对于子宫前 (aHR1.06) 或FGR (aHR0.95) 没有发现显著的关联.
- 特别是在可代因和 oxycodone 单独治疗时,特别注意到脱胎和早产的风险增加.
结论:
- 母亲使用止痛类阿片类药物,特别是可代因和 oxycodone,与早产和胎盘断裂的风险略有增加有关.
- 这些发现强调了在怀孕期间仔细考虑阿片类药物处方的重要性.
相关概念视频
Opioid Analgesics: Synthetic and Semisynthetic Opioids
433
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
433
Analgesia and Pain Management
791
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
791
Opioid Analgesics: Morphine and Other Natural Cogeners
361
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
361
Local Anesthetics: Clinical Application as Epidural Anesthesia
498
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
498
Teratogenicity
2.8K
The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
2.8K
Parenteral Anesthetics: Overview
198
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
198


