Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder
Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder
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DOI：
10.1016/j.drugalcdep.2015.02.012
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发表时间：
2015-04-01
影响因子：
4.2
通讯作者：
Winhusen, Theresa
中科院分区：
文献类型：
--
作者：
Wilder, Christine;Lewis, Daniel;Winhusen, Theresa
背景：阿片类药物使用的增加导致了孕妇和产后接受药物辅助治疗(MAT)治疗阿片类药物使用障碍的人数的增加。方法：我们(1)对已发表的关于孕妇和产后停用阿片类药物(美沙酮和丁丙诺啡)的文献进行了系统的综述，(2)确定了2006年至2013年美沙酮临床附属大学孕妇和产后美沙酮的停用率。结果：我们发现了有限的关于停用阿片类药物的一般性文献报道，产前停用率从0到33%，产前和产后不同时期的停用率从26%到。在我们的229名妇女队列中，报告了251例怀孕，产前美沙酮停用率为11.0%。根据控制年龄、妊娠结局和分娩前治疗时间的Cox比例风险模型，在产后6个月或之前停用美沙酮的概率为56.0%。分娩前服用美沙酮的时间与产后停药的风险呈负相关(HR=0.98，95%CI(0.96，0.99))。结论：产后是停用MAT的高危时期。有必要对产前和产后垫片停用率进行更准确的评估，并进一步调查影响这些比率的因素。制定和测试干预措施，鼓励产前及早参加MAT，并改善产后在MAT中的滞留，将使患有阿片类药物使用障碍的孕妇和新母亲受益。爱思唯尔爱尔兰有限公司出版。
Background: Increasing use of opioids has led to an increase in the number of pregnant and postpartum women in medication assisted treatment (MAT) for opioid use disorder.Methods: We (1) conducted a systematic review of published literature on MAT discontinuation (methadone and buprenorphine) in pregnant and postpartum women and (2) determined methadone discontinuation rates in a retrospective cohort (2006-2013) of pregnant and postpartum women in a university affiliated methadone clinic.Results: We found limited generalizable literature reports of discontinuation rates, with a range of prenatal discontinuation rates from 0 to 33% and rates which spanned various prenatal and postnatal periods from 26 to 64%. In our cohort of 229 women, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11.0%. Based on a Cox proportional hazards model controlling for age, pregnancy outcome, and duration of treatment prior to delivery, the probability of methadone discontinuation at or before 6 months postpartum was 56.0%. Duration of methadone treatment prior to delivery was inversely associated with risk for postpartum discontinuation of treatment (HR = 0.98, 95% CI (0.96, 0.99)).Conclusions: We conclude that the postpartum period is a time of increased risk for discontinuation of MAT. More accurate assessment of rates of pre- and postpartum MAT discontinuation, as well as further investigation of factors affecting these rates, is warranted. Development and testing of interventions to encourage early prenatal enrollment in MAT and improve postnatal retention in MAT would benefit pregnant women and new mothers with opioid use disorder. Published by Elsevier Ireland Ltd.