Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery
Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery
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DOI：
10.1111/add.14825
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发表时间：
2019-11-13
期刊：
影响因子：
6
通讯作者：
Schiff, Davida M.
中科院分区：
文献类型：
--
作者：
Nielsen, Timothy;Bernson, Dana;Schiff, Davida M.
背景和目的阿片类药物过量与妊娠相关死亡的关系越来越密切，但与产后过量相关的因素尚不清楚。我们的目的是估计产妇和婴儿的特点和产后阿片类药物相关的过量之间的关联的强度。设计：回顾性队列研究，使用一个链接的，人口水平的数据集。背景马萨诸塞州，美国。结论2012年至2014年期间，在美国马萨诸塞州分娩活婴的妇女中，母亲诊断为OUD、既往非致命性药物过量、婴儿诊断为NAS和高计划外医疗保健利用似乎与产后阿片类药物过量呈正相关。然而，在此期间，超过一半的产后过量用药是没有诊断出OUD的妇女。在分娩前一个月接受美沙酮或丁丙诺啡治疗不足以降低产后用药过量的几率。参与者2012年至2014年分娩一次或多次活产的女性（n = 174 517）。主要结局是产后一年中阿片类药物相关过量。我们使用多变量logistic回归来探讨产妇（人口统计学、物质使用、妊娠）和婴儿[胎龄、出生体重、新生儿戒断综合征（NAS）]特征与产后阿片类药物过量的独立关联。研究结果分层的母亲阿片类药物使用障碍（OUD）的诊断。有189名分娩的妇女在产后第一年经历了>= 1阿片类药物过量（11/10000分娩）。在产后阿片类药物过量的妇女中，46.6%在分娩前12个月内诊断为OUD。在我们的校正模型中，母亲诊断OUD [校正比值比（aOR）= 3.61，95%置信区间（CI）= 1.73-7.51]和既往非致死性药物过量（aOR = 2.40，95% CI = 1.11-5.17）与产后药物过量最密切相关。按OUD状态分层后，（OUD+ aOR = 2.03，95% CI = 1.26-3.27; OUD- aOR = 2.79，95% CI = 1.12-6.93）和计划外医疗利用率高（OUD+ aOR = 2.27，95% CI = 1.38-3.73; OUD- aOR = 2.11，95% CI = 1.24-3.58）与两组中产后用药过量呈正相关。
Background and Aims Opioid-related overdose is increasingly linked to pregnancy-associated deaths, but factors associated with postpartum overdose are unknown. We aimed to estimate the strength of the association between maternal and infant characteristics and postpartum opioid-related overdose. Design Retrospective cohort study using a linked, population-level data set. Setting Massachusetts, United States. Conclusion Among women who delivered live infants in Massachusetts, USA between 2012 and 2014, maternal diagnosis of OUD, prior non-fatal overdose, infant diagnosis of NAS and high unscheduled health-care utilization appeared to be positively associated with postpartum opioid overdose. However, more than half of postpartum overdoses in that period were to women without a diagnosis of OUD. Engagement in methadone or buprenorphine treatment in the month prior to delivery was not sufficient to reduce the odds of postpartum overdose. Participants Women who delivered one or more live births from 2012 to 2014 (n = 174 517). Measurements The primary outcome was opioid-related overdose in the postpartum year. We used multivariable logistic regression to explore the independent associations of maternal (demographics, substance use, pregnancy) and infant [gestational age, birthweight, neonatal abstinence syndrome (NAS)] characteristics with postpartum opioid overdose. Findings were stratified by maternal opioid use disorder (OUD) diagnosis. Findings There were 189 deliveries to women who experienced >= 1 opioid overdose in the first year postpartum (11 of 10 000 deliveries). Among women with postpartum opioid overdose, 46.6% had an OUD diagnosis within 12 months before delivery. In our adjusted model, maternal diagnosis of OUD [adjusted odds ratio (aOR) = 3.61, 95% confidence interval (CI) = 1.73-7.51] and prior non-fatal overdose (aOR = 2.40, 95% CI = 1.11-5.17) were most strongly associated with postpartum overdose. After stratifying by OUD status, infant diagnosis of NAS (OUD+ aOR = 2.03, 95% CI = 1.26-3.27; OUD- aOR = 2.79, 95% CI = 1.12-6.93) and high unscheduled health-care utilization (OUD+ aOR = 2.27, 95% CI = 1.38-3.73; OUD- aOR = 2.11, 95% CI = 1.24-3.58) were positively associated with postpartum overdose in both groups.