Outcomes associated with the use of medications for opioid use disorder during pregnancy.
Outcomes associated with the use of medications for opioid use disorder during pregnancy.
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DOI：
10.1111/add.15582
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Jarlenski MP
中科院分区：
文献类型：
--
作者：
Krans EE;Kim JY;Chen Q;Rothenberger SD;James AE 3rd;Kelley D;Jarlenski MP
To test the effect of the duration of medication for opioid use disorder (MOUD) use during pregnancy on maternal, perinatal, and neonatal outcomes. Retrospective cohort analysis of claims, encounter, and pharmacy data. Pennsylvania, USA. We analyzed 13,320 pregnancies among 10,741 women with opioid use disorder aged 15–44 years enrolled in Pennsylvania Medicaid between 2009 and 2017. We examined five outcomes during pregnancy and for 12 weeks postpartum: (1) overdose, (2) postpartum MOUD continuation, (3) preterm birth (<37 weeks gestation), (4) term low birthweight (<2,500 grams at ≥ 37 weeks), and (5) neonatal abstinence syndrome (NAS). Our primary exposure was the duration (count of weeks) of any MOUD use, including methadone or buprenorphine, during pregnancy. Among 13,320 pregnancies, 306 (2.3%) were complicated by an overdose, 1,753 (13.2%) resulted in a preterm birth and 6,787 (50.9%) continued MOUD postpartum. Among infants, 874 (7.6%) were low birthweight at term and 7,706 (57.9%) were diagnosed with NAS. As the duration of MOUD use increased, we found a statistically significant decrease in the rate of overdose and preterm birth, a statistically significant increase in the rate of postpartum MOUD continuation and NAS, and a decline in term low birthweight. Specifically, for each additional week of MOUD, the adjusted odds of overdose decreased by 2% (aOR 0.98; 95% CI: 0.97,0.99), preterm birth decreased by 1% (aOR: 0.99; 95% CI: 0.99,1.00), postpartum MOUD continuation increased by 95% (aOR: 1.95; 95% CI: 1.87, 2.04) and NAS increased by 41% (aOR: 1.41; 95% CI 1.35, 1. 47). The odds of term low birthweight did not change (aOR: 1.00; 95% CI: 0.99, 1.00), although the rate declined with a longer duration of MOUD use during pregnancy. Longer duration of medication for opioid use disorder use during pregnancy appears to be associated with improved maternal and perinatal outcomes.
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