Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts
Fatal and Nonfatal Overdose Among Pregnant and Postpartum Women in Massachusetts
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DOI：
10.1097/aog.0000000000002734
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发表时间：
2018-08-01
影响因子：
7.2
通讯作者：
Land, Thomas
中科院分区：
文献类型：
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作者：
Schiff, Davida M.;Nielsen, Timothy;Land, Thomas
目的：估计马萨诸塞州孕妇和产后妇女的致死性和非致死性阿片类药物过量事件，比较接受和未接受阿片类药物使用障碍（OUD）药物治疗的个体的发生率。方法：我们进行了一项基于人群的回顾性队列研究，使用马萨诸塞州的相关行政和生命统计数据库，以确定2012-2014年分娩活产新生儿的有OUD证据的妇女。我们描述了产妇的社会人口统计学、医疗和药物使用特征，计算了分娩前后一年阿片类药物过量事件的发生率，并比较了产前和产后接受美沙酮或丁丙诺啡药物治疗的过量率。结果：在177，876次单独交付中，（2.3%）是在分娩前一年有OUD证据的女性，共发生242起阿片类药物相关过量事件（231例非致命性，11例致命性）在分娩前或分娩后一年。总体用药过量率为8.0/100，000人-天。药物过量在妊娠晚期最低（妊娠晚期3.3/100，000人-天），然后在产后期间增加，分娩后7-12个月的药物过量率最高（12.3/100，000人-天）。总体而言，64.3%的女性在分娩前一年有OUD的证据，在分娩前一年接受任何药物治疗。接受药物治疗的妇女在产后早期用药过量率降低。结论：马萨诸塞州的孕妇有很高的OUD率。分娩后的一年是OUD妇女的脆弱时期。需要为产后第一年的妇女量身定制额外的纵向支持和干预措施，以预防和减少过量用药事件。
OBJECTIVE: To estimate fatal and nonfatal opioid overdose events in pregnant and postpartum women in Massachusetts, comparing rates in individuals receiving and not receiving pharmacotherapy for opioid use disorder (OUD).METHODS: We conducted a population-based retrospective cohort study using linked administrative and vital statistics databases in Massachusetts to identify women with evidence of OUD who delivered a liveborn neonate in 2012-2014. We described maternal sociodemographic, medical, and substance use characteristics, computed rates of opioid overdose events in the year before and after delivery, and compared overdose rates by receipt of pharmacotherapy with methadone or buprenorphine in the prenatal and postpartum periods.RESULTS: Among 177,876 unique deliveries, 4,154 (2.3%) were to women with evidence of OUD in the year before delivery, who experienced 242 total opioid-related overdose events (231 nonfatal, 11 fatal) in the year before or after delivery. The overall overdose rate was 8.0 per 100,000 person-days. Overdoses were lowest in the third trimester (3.3/100,000 person-days in the third trimester) and then increased in the postpartum period with the highest overdose rate 7-12 months after delivery (12.3/100,000 person-days). Overall, 64.3% of women with evidence of OUD in the year before delivery received any pharmacotherapy in the year before delivery. Women receiving pharmacotherapy had reduced overdose rates in the early postpartum period.CONCLUSION: Pregnant women in Massachusetts have high rates of OUD. The year after delivery is a vulnerable period for women with OUD. Additional longitudinal supports and interventions tailored to women in the first year postpartum are needed to prevent and reduce overdose events.