Maternal Complications and Prescription Opioid Exposure During Pregnancy: Using Marginal Structural Models.
Maternal Complications and Prescription Opioid Exposure During Pregnancy: Using Marginal Structural Models.
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DOI：
10.1007/s40264-021-01115-6
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发表时间：
2021-12
期刊：
影响因子：
4.2
通讯作者：
Meador KJ
中科院分区：
文献类型：
--
作者：
Wen X;Wang S;Lewkowitz AK;Ward KE;Brousseau EC;Meador KJ
处方阿片类药物经常用于怀孕期间的疼痛管理。对妊娠期间接受处方阿片类药物的母亲的围产期并发症的研究仍然有限。本研究的目的是评估处方阿片类药物使用与孕产妇妊娠和产科并发症的相关性。这项回顾性队列研究使用了2008-2015年期间与生命统计相关的罗得岛（RI）医疗补助索赔数据，包括年龄在12-55岁之间的一胎或多胎活产孕妇。如果妇女在怀孕前而不是怀孕期间患有癌症，阿片类药物使用障碍或阿片类药物分配，则将其排除在外。主要结局包括不良妊娠和产科并发症。采用具有时变暴露和协变量的边际结构考克斯模型控制基线和协变量。对阿片类药物暴露后1周（主要）或暴露同一周内（次要）发生的结局进行分析。进行了敏感性研究，以评估不同剂量和单个阿片类药物的影响。在9823名符合条件的母亲中，545名（5.5%）在怀孕期间服用了一种或多种处方阿片类药物。与未暴露者相比，在主要分析中未观察到显著风险，而在次要分析中，阿片类药物暴露的母亲与剖宫产产前抑郁症（HR 3.19; 95% CI 1.22-8.33）和心脏事件（HR 9.44; 95% CI 1.19-74.83）的风险增加相关。在敏感性分析中，高剂量暴露的结果更加突出，并且对于单个阿片类药物来说是一致的。怀孕期间使用处方阿片类药物与母体并发症的风险增加有关。
Prescription opioids are frequently used for pain management in pregnancy. Studies examining perinatal complications in mothers who received prescription opioids during pregnancy are still limited. The aim of this study was to assess the association of prescription opioid use and maternal pregnancy and obstetric complications. This retrospective cohort study with the Rhode Island (RI) Medicaid claims data linked to vital statistics throughout 2008–2015 included pregnant women aged 12–55 years with one or multiple live births. Women were excluded if they had cancer, opioid use disorder, or opioid dispensing prior to but not during pregnancy. Main outcomes included adverse pregnancy and obstetric complications. Marginal Structural Cox Models with time-varying exposure and covariates were applied to control for baseline and time-varying covariates. Analyses were conducted for outcomes that occurred 1 week after opioid exposure (primary) or within the same week as exposure (secondary). Sensitivity studies were conducted to assess the effects of different doses and individual opioids. Of 9823 eligible mothers, 545 (5.5%) filled one or more prescription opioid during pregnancy. Compared with those unexposed, no significant risk was observed in primary analyses, while in secondary analyses opioid-exposed mothers were associated with an increased risk of cesarean antepartum depression (HR 3.19; 95% CI 1.22–8.33), and cardiac events (HR 9.44; 95% CI 1.19–74.83). In sensitivity analyses, results are more prominent in high dose exposure and are consistent for individual opioids. Prescription opioid use during pregnancy is associated with an increased risk of maternal complications.
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影响因子：
9.8
作者：
Broussard, Cheryl S.;Rasmussen, Sonja A.;Honein, Margaret A.
通讯作者：
Honein, Margaret A.
CDC规定慢性疼痛的阿片类药物的指南 - 美国，2016年。
DOI：
10.1001/jama.2016.1464
发表时间：
2016-04-19
期刊：
JAMA
影响因子：
--
作者：
Dowell D;Haegerich TM;Chou R
通讯作者：
Chou R
影响因子：
33.7
作者：
Dowell, Deborah;Haegerich, Tamara M.;Chou, Roger
通讯作者：
Chou, Roger
影响因子：
5.3
作者：
Bogen, Debra L.;Hanusa, Barbara H.;Wisner, Katherine L.
通讯作者：
Wisner, Katherine L.
影响因子：
5.5
作者：
通讯作者：
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