Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child.
Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus and child.
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DOI：
10.1111/add.13462
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发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Jones HE
中科院分区：
文献类型：
--
作者：
Zedler BK;Mann AL;Kim MM;Amick HR;Joyce AR;Murrelle EL;Jones HE
评估丁丙诺啡与美沙酮相比治疗患有阿片类药物使用障碍的孕妇的安全性。我们检索了 PubMed、Embase 和 Cochrane 图书馆从成立到 2015 年 2 月的随机对照试验 (RCT) 和观察性队列研究 (OBS)，这些研究比较了丁丙诺啡与美沙酮治疗阿片类药物依赖孕妇的效果。两名评审员独立评估了所有检索结果的标题和摘要以及可能符合条件的研究的全文，报告了孕产妇/胎儿/婴儿死亡、早产、胎儿生长结果、胎儿/先天异常、胎儿/儿童神经发育和/或母体不良事件的原始数据。我们使用经过验证的仪器确定了每项研究的偏倚风险，并使用既定方法评估了每项结果的证据强度。我们使用随机效应模型计算了两项或多项研究中每个结果的效应大小。 3 个随机对照试验 (n = 223) 和 15 个队列 OBS (n = 1923) 符合纳入标准。在使用未经调整的数据和美沙酮作为比较的荟萃分析中，丁丙诺啡与较低的早产风险相关[RCT风险比（RR） = 0.40，95％置信区间（CI） = 0.18，0.91； OBS RR = 0.67, 95% CI = 0.50, 0.90]，出生体重较大[RCT加权平均差（WMD） = 277 g，95% CI = 104, 450； OBS WMD = 265 g, 95% CI = 196, 335]及较大头围[RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66； OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]。对于自发性胎儿死亡、胎儿/先天性异常和其他胎儿生长指标，没有观察到治疗差异，尽管由于样本量较小，检测此类差异的能力可能不足。中等强度的证据表明，与美沙酮治疗相比，用丁丙诺啡治疗孕期阿片类药物使用障碍的早产风险更低、出生体重更大、头围更大，而且没有更大的危害。
To assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder. We searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid‐dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random‐effects models for each outcome with two or more studies. Three RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta‐analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes. Moderately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.
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影响因子：
4.6
作者：
DiPietro, JA;Hodgson, DM;Johnson, TRB
通讯作者：
Johnson, TRB
影响因子：
7.2
作者：
Chou, Roger;Aronson, Naomi;Moher, David
通讯作者：
Moher, David
影响因子：
7.2
作者：
Dashe, JS;Jackson, GL;Wendel, GD
通讯作者：
Wendel, GD
影响因子：
3.8
作者：
BOER, K;SMIT, BJ;HOGERZEIL, HV
通讯作者：
HOGERZEIL, HV
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N