在怀孕和分娩后果中继续使用处方刺激剂
Shaquib Al Hasan1, Meena Murugappan1, Sarah Westberg1
1Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis, USA.
怀孕早期使用兴奋剂并没有增加风险,但持续使用兴奋剂到第二或第三个三个月与较高的死产,早产和高血压疾病率有关.
科学领域:
- 产周医学 产周医学
- 在怀孕期间的药理学.
- 孕产妇和胎儿的医学
背景情况:
- 关于怀孕期间使用处方兴奋剂对母亲和胎儿的风险存在不一致的发现.
- 缺乏关于孕妇使用兴奋剂的明确临床指导.
- 需要评估整个妊娠连续性的风险.
研究的目的:
- 评估与处方兴奋剂暴露相关的孕产妇和胎儿风险.
- 在整个怀孕期间评估风险,从早期暴露到持续使用.
- 利用大量的,商业保险的美国人口进行全面分析.
主要方法:
- 一个大型行政索赔数据库 (2013-2021) 的回顾性分析.
- 将暴露于兴奋剂的怀孕与与非暴露的怀孕相匹配的队列进行比较.
- 倾向分数匹配 (1:1贪的邻居) 用于控制临床条件和药物.
主要成果:
- 早期的兴奋剂暴露 (仅在第一季度) 与更高的活产率和更低的自发流产和早产风险有关.
- 持续暴露于兴奋剂 (二/三季度) 增加了胎盘断裂,孕前,妊娠高血压和早产的风险.
- 与早期暴露相比,延续到晚期的三个月显示出死亡出生,自发流产,早产,胎盘断裂和子宫前的风险明显更高.
结论:
- 早期 (头三个月) 的兴奋剂暴露似乎不会增加母亲或胎儿的风险.
- 在第二和/或第三季度继续服用兴奋剂与死产,早产,高血压疾病和胎盘断裂的风险增加有关.
- 临床医生在怀孕期间使用兴奋剂治疗ADHD时,应仔细考虑这些风险.
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