Opioid Use and Opioid Use Disorder in Pregnancy
Opioid Use and Opioid Use Disorder in Pregnancy
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DOI：
10.1097/aog.0000000000002235
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发表时间：
2017-08-01
影响因子：
7.2
通讯作者：
Terplan, Mishka
中科院分区：
文献类型：
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作者：
Mascola, Maria A.;Borders, Ann E.;Terplan, Mishka
近年来，妊娠期阿片类药物的使用急剧增加，与普通人群中观察到的流行病平行。为了对抗阿片类药物的流行，所有医疗保健提供者都需要发挥积极作用。怀孕为识别和治疗患有药物滥用障碍的女性提供了重要的机会。药物使用障碍影响所有种族和族裔群体以及所有社会经济群体的妇女，并影响农村、城市和郊区人口的妇女。因此，筛查的普及至关重要。物质使用筛查应成为综合产科护理的一部分，并应在第一次产前检查时与孕妇合作进行。怀孕期间使用阿片类药物的患者是一个多元化的群体，认识和区分医疗护理中阿片类药物的使用、阿片类药物滥用和未经治疗的阿片类药物使用障碍非常重要。多学科长期随访应包括医疗、发育和社会支持。儿科护理人员应监测在怀孕期间使用阿片类药物的妇女所生的婴儿是否有新生儿戒断综合征。早期普遍筛查、简短干预（例如与患者进行简短对话、提供反馈和建议）以及对阿片类药物使用和阿片类药物使用障碍孕妇的转诊治疗可改善母婴结局。一般来说，没有刑事制裁的协调多学科方法最有可能帮助婴儿和家庭。
Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders. Substance use disorders affect women across all racial and ethnic groups and all socioeconomic groups, and affect women in rural, urban, and suburban populations. Therefore, it is essential that screening be universal. Screening for substance use should be a part of comprehensive obstetric care and should be done at the first prenatal visit in partnership with the pregnant woman. Patients who use opioids during pregnancy represent a diverse group, and it is important to recognize and differentiate between opioid use in the context of medical care, opioid misuse, and untreated opioid use disorder. Multidisciplinary long-term follow-up should include medical, developmental, and social support. Infants born to women who used opioids during pregnancy should be monitored for neonatal abstinence syndrome by a pediatric care provider. Early universal screening, brief intervention (such as engaging a patient in a short conversation, providing feedback and advice), and referral for treatment of pregnant women with opioid use and opioid use disorder improve maternal and infant outcomes. In general, a coordinated multidisciplinary approach without criminal sanctions has the best chance of helping infants and families.