Medication-Assisted Treatment Use Among Pregnant Women With Opioid Use Disorder
Medication-Assisted Treatment Use Among Pregnant Women With Opioid Use Disorder
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DOI：
10.1097/aog.0000000000003231
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发表时间：
2019-05-01
影响因子：
7.2
通讯作者：
Jarlenski, Marian P.
中科院分区：
文献类型：
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作者：
Krans, Elizabeth E.;Kim, Joo Yeon;Jarlenski, Marian P.
目的：为了评估阿片类药物使用disorder.METHODS孕妇中药物辅助治疗使用的时间趋势：我们使用宾夕法尼亚州医疗补助管理数据进行了一项回顾性队列研究。使用药房记录和程序代码计算药物辅助治疗使用、阿片类药物治疗（美沙酮和丁丙诺啡）和行为健康咨询的趋势。Cochrane-Armitage检验评估了使用美沙酮与丁丙诺啡相比孕妇特征的线性趋势。结果：我们总共评估了10，741名阿片类药物使用障碍妇女中的12，587例妊娠，这些妇女在2009年至2015年期间活产。在所有年份中，44.1%的孕妇没有接受阿片类药物治疗，27.1%使用丁丙诺啡，28.8%使用美沙酮。不到一半的女性在怀孕期间接受过任何行为健康咨询。美沙酮使用的调整流行率从31.6%下降到2010年的31.6%，（95%置信区间29.3-33.9%）降至25.2%（95% CI 23.3-27.1%），而丁丙诺啡使用的校正患病率从15.8%（95% CI 13.9-17.8%）增加至30.9%（95% CI 28.8-33.0%）。丁丙诺啡的使用在具有大都市中心的地理区域，如西南部（增加24.9%）和东南部（增加12.0%），而主要是农村地区，如新西部（增加5.2%）。2015年调整后的孕期行为健康咨询就诊人次为3.4人次（95% CI 2.6-4.1）在使用丁丙诺啡的女性中，4.0（95% CI 3.3-4.7）未使用药物治疗的女性，6.4（95%CI 4.9-7.9）。结论：随着时间的推移，在接受医疗补助的阿片类药物使用障碍孕妇中，丁丙诺啡的使用显著增加，同时美沙酮的使用也有小幅下降。行为健康咨询的使用率很低，但在使用美沙酮的妇女中最高。
OBJECTIVE: To evaluate temporal trends in medication-assisted treatment use among pregnant women with opioid use disorder.METHODS: We conducted a retrospective cohort study using Pennsylvania Medicaid administrative data. Trends in medication-assisted treatment use, opioid pharmacotherapy (methadone and buprenorphine) and behavioral health counselling, were calculated using pharmacy records and procedure codes. Cochrane-Armitage tests evaluated linear trends in characteristics of pregnant women using methadone compared with buprenorphine.RESULTS: In total, we evaluated 12,587 pregnancies among 10,741 women with opioid use disorder who had a live birth between 2009 and 2015. Across all years, 44.1% of pregnant women received no opioid pharmacotherapy, 27.1% used buprenorphine, and 28.8% methadone. Fewer than half of women had any behavioral health counseling during pregnancy. The adjusted prevalence of methadone use declined from 31.6% (95% CI 29.3-33.9%) in 2009 to 25.2% (95% CI 23.3-27.1%) in 2015, whereas the adjusted prevalence of buprenorphine use increased from 15.8% (95% CI 13.9-17.8%) to 30.9% (95% CI 28.8-33.0%). Greater increases in buprenorphine use were found in geographic regions with large metropolitan centers, such as the Southwest (plus 24.9%) and the Southeast (plus 12.0%), compared with largely rural regions, such as the New West (plus 5.2%). In 2015, the adjusted number of behavioral health counseling visits during pregnancy was 3.4 (95% CI 2.6-4.1) among women using buprenorphine, 4.0 (95% CI 3.3-4.7) among women who did not use pharmacotherapy, and 6.4 (95% CI 4.9-7.9) among women using methadone.CONCLUSION: Buprenorphine use among Medicaid-enrolled pregnant women with opioid use disorder increased significantly over time, with a small concurrent decline in methadone use. Behavioral health counseling use was low, but highest among women using methadone.