Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance.
Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance.
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DOI：
10.1097/adm.0000000000000308
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发表时间：
2017
影响因子：
5.5
通讯作者：
Jones HE
中科院分区：
文献类型：
--
作者：
Klaman SL;Isaacs K;Leopold A;Perpich J;Hayashi S;Vender J;Campopiano M;Jones HE
怀孕期间阿片类药物使用障碍（OUD）的患病率正在增加。实用的建议将有助于提供者治疗患有OUD的孕妇，并减少对母亲、胎儿和儿童的潜在负面健康后果。本文总结了由美国卫生和人类服务部物质滥用和精神卫生服务管理局完成的兰德/加州大学洛杉矶分校适当性方法项目所进行的文献综述，以获得有关孕妇和养育患有OUD的妇女及其婴儿和儿童的治疗方法的现有证据。采用三种不同的搜索方法来识别同行评议的期刊文章，这些文章提供了怀孕或育儿的OUD妇女及其子女的治疗方法的证据。根据研究指南对确定的文章进行审查，并对相关信息进行摘要和总结。在确定的1697篇文章中，有75篇被纳入文献综述。围产期在综合治疗中使用美沙酮或丁丙诺啡进行成瘾治疗（MAT，也称为药物辅助治疗）是最被接受的临床做法，因为戒断或戒毒有复发和退出治疗的风险。妊娠晚期可能需要增加药物治疗，与更严重的新生儿戒断综合征（NAS）无关。通常不建议在产前更换药物，因为它会破坏阿片类药物的戒断。产后，母乳喂养被认为对维持稳定剂量阿片类激动剂药物的妇女婴儿有益。对于理想的疼痛管理和产后给药方案知之甚少。产前暴露于丁丙诺啡和美沙酮后，NAS通常不那么严重。一线NAS药物治疗包括方案驱动的美沙酮和吗啡剂量在非药物支持的情况下。患有OUD的妇女在怀孕期间可以用美沙酮或丁丙诺啡治疗。NAS是一种预期的、可管理的状态。尽管研究取得了实质性进展，但仍提供了指导未来研究以改善孕产妇和婴儿结局的机会。
The prevalence of opioid use disorder (OUD) during pregnancy is increasing. Practical recommendations will help providers treat pregnant women with OUD and reduce potentially negative health consequences for mother, fetus, and child. This article summarizes the literature review conducted using the RAND/University of California, Los Angeles Appropriateness Method project completed by the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration to obtain current evidence on treatment approaches for pregnant and parenting women with OUD and their infants and children. Three separate search methods were employed to identify peer-reviewed journal articles providing evidence on treatment methods for women with OUD who are pregnant or parenting, and for their children. Identified articles were reviewed for inclusion per study guidelines and relevant information was abstracted and summarized. Of the 1697 articles identified, 75 were included in the literature review. The perinatal use of medication for addiction treatment (MAT, also known as medication-assisted treatment), either methadone or buprenorphine, within comprehensive treatment is the most accepted clinical practice, as withdrawal or detoxification risks relapse and treatment dropout. Medication increases may be needed with advancing pregnancy, and are not associated with more severe neonatal abstinence syndrome (NAS). Switching medication prenatally is usually not recommended as it can destabilize opioid abstinence. Postnatally, breastfeeding is seen as beneficial for the infant for women who are maintained on a stable dose of opioid agonist medication. Less is known about ideal pain management and postpartum dosing regimens. NAS appears generally less severe following prenatal exposure to buprenorphine versus methadone. Frontline NAS medication treatments include protocol-driven methadone and morphine dosing in the context of nonpharmacological supports. Women with OUD can be treated with methadone or buprenorphine during pregnancy. NAS is an expected and manageable condition. Although research has substantially advanced, opportunities to guide future research to improve maternal and infant outcomes are provided.