Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study
Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study
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DOI：
10.1159/000509048
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发表时间：
2021-03-01
影响因子：
3.9
通讯作者：
Mravcik, Viktor
中科院分区：
文献类型：
--
作者：
Gabrhelik, Roman;Skurtveit, Svetlana;Mravcik, Viktor
背景：对于母亲在怀孕期间使用甲基苯丙胺（MA）后对新生儿的不良后果了解有限。目的：比较暴露于 MA 的新生儿与暴露于阿片类药物的母亲和普通人群 (GP) 母亲的新生儿的新生儿结局。方法：使用捷克全国登记处进行的队列研究（2000-2014 年）。怀孕期间因主要诊断为 MA 使用障碍而住院的妇女 (n = 258) 及其新生儿被定义为 MA 暴露人群。对照组包括在怀孕期间被诊断患有阿片类药物使用障碍（定义为阿片类药物暴露）的女性（n = 199）和没有药物使用障碍诊断（GP）的女性（n = 1,511,310）。研究的新生儿结局包括生长参数、胎龄、早产和阿普加评分。为了探讨 MA 暴露与新生儿结局之间的关联，估计了多变量线性和二元 Logistic 回归的回归系数 (b) 和优势比。结果：接触 MA 的女性与接触阿片类药物的女性具有相似的社会经济特征，两者都比 GP 更差。调整后，与阿片类药物暴露相比，MA 暴露与更有利的出生体重（调整后平均差 [aMD] b = 122.3 g，95% CI：26.0-218.5）和身长（aMD b = 0.6 cm，0.0-1.1）相关。与 GP 比较的未经调整的结果表明，MA 组的新生儿结局较差，特别是在生长参数方面。背景特征的调整对与 GP 的比较产生了深远的影响。调整后，MA暴露仅与出生体重（aMD b = -63.0 g，-123.0至-3.1）和出生身长（aMD b = -0.3 cm，-0.6至0.0）略有降低相关。结论：虽然在 MA 暴露的新生儿中观察到的负面结果较大，但调整对与 GP 的比较产生了深远的影响，表明生活方式和社会经济因素对这些高危妊娠的影响很大。与阿片类药物暴露相比，MA 暴露的新生儿具有更好的新生儿结局。
Background: There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. Objectives: To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). Method: A cohort study using nationwide registries in Czechia (2000-2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated. Results: MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0-218.5) and length (aMD b = 0.6 cm, 0.0-1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = -63.0 g, -123.0 to -3.1) and birth length (aMD b = -0.3 cm, -0.6 to 0.0). Conclusions: Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.