Utilising linked administrative datasets to explore the developmental pathways of children born to women who use opioids in pregnancy

我们为什么需要这项研究？在国际上，阿片类药物使用的增加被描述为一场危机。在苏格兰，每年约有500名儿童出生于使用阿片类药物的妇女，例如海洛因和美沙酮。我们对这些儿童所知甚少的是，他们在生命的最初几年可能健康状况较差。我们还知道，他们更有可能在其他方面处于不利地位，例如生活贫困和住房不稳定。所进行的研究往往是在有限的时间内收集少数儿童的数据。这是因为这些家庭的生活往往相当混乱，而且可能经常搬家，这使得研究人员很难保持联系，并随着时间的推移返回采访他们。这导致缺乏有关这些儿童长期情况的信息，以及他们可能需要额外支持的地方。我们也不太了解这些孩子在出生时受到的不同待遇的影响，以及是什么让这些孩子比其他孩子更健康和发育。这项研究将涉及什么？这项研究分三个阶段进行，首先，我们将与一系列与吸毒妇女打交道的人交谈，了解他们记录这些家庭数据的方式，如助产士、卫生访视员、护士、医生和社会工作者。我们想从他们那里了解为什么他们以某些方式记录数据，是否有任何数据丢失或不完整，以及数据的可靠性如何。这些信息将用于通知主研究，主研究将使用医院记录、出生记录和学校记录中记录的数据。在苏格兰，每个人都有一个唯一的健康ID号，这使得他们的数据可以链接在一起。研究的第二阶段将汇集来自卫生、教育和社会工作的数据，使我们能够比较不同儿童群体的情况。这些群体将包括母亲在怀孕期间使用美沙酮等阿片类药物的儿童，因为他们对海洛因等非法药物上瘾，以及母亲在怀孕期间使用阿片类药物缓解慢性疼痛的儿童，以及同样处于不利地位的儿童，例如生活在贫困中，但母亲在怀孕期间没有使用阿片类药物。在这一阶段，我们将研究不同的健康指标，例如儿童是否肥胖/超重，是否因意外和受伤而入院，或是否患有哮喘等疾病。我们将试图找出不同儿童群体之间这些结果的差异，以及与这些结果相关的其他风险（例如早产或母亲在怀孕期间吸烟）。这项研究的第三阶段将研究在怀孕期间使用阿片类药物的母亲所生孩子的社会工作数据。这些儿童中的许多人将有一段时间远离家庭，与其他家庭成员或寄养家庭一起生活。我们将研究不同照顾者之间的移动模式，以及哪些因素使儿童更容易在离家后接受不同模式的照顾。然后，我们将研究与没有离家生活的儿童相比，离家照顾是否会导致不同的健康和发育结果。谁将受益？我们的研究结果将以不同的方式帮助一系列人和机构。它将使吸毒妇女及其孩子受益，因为它将有助于展示实践和政策如何更好地满足她们的需求。它将使社会更广泛地受益，因为它将使人们更好地了解父母及其家庭的日常生活。它还将使专业人员、服务机构和政策制定者受益，使他们对这些家庭需要什么来支持他们，使他们的孩子有一个最好的人生开端有了新的认识。此外，委员会亦会建议我们如何搜集有关这些家庭的更佳资料，以改善服务。

Why do we need this study?Internationally, the rising use of opioid drugs has been described as a crisis. In Scotland, around 500 children a year are born to women who use opioid drugs, for example, heroin and methadone. The little we do know about these children is that they are likely to have poorer health in the first few years of life. We also know that they are more likely to be disadvantaged in other ways, e.g. living in poverty and in unstable housing. The research which has been conducted tends to have collected data on small numbers of children for a limited period of time. This is because these families often have pretty chaotic lives, and may move around a lot, making it difficult for researchers to keep in contact and return to interview them over time.This has led to a lack of information about what happens to these children in the longer term, and where they might need additional support. We also don't know much about the impact of differences in how these children are treated when they are born, and what makes some of these children have better health and development than others.What will the study involve?This study has three stages to it. Firstly we will speak to a range of people who work with women who use drugs about the way that they record data on these families, e.g. midwives, health visitors, nurses, doctors and social workers. We want to find out from them why they record data in certain ways, whether any data is missing or incomplete, and how reliable data are. This information will be used to inform the main study, which will use data recorded in hospital records, birth records, and school records, for example. In Scotland, everyone has a unique health ID number, which allows their data to be linked together. The second stage of the study will bring together data from health, education and social work, to allow us to compare what happens to different groups of children. These groups will contain children who had a mother who used opioids such as methadone in pregnancy because they are addicted to illegal drugs, such as heroin, as well as a group of children whose mother used opioids in pregnancy as chronic pain relief, and children who are similarly disadvantaged, for example living in poverty, but did not have a mother who used opioids in pregnancy. At this stage, we will look at different measures of health, e.g. whether children are obese/overweight, have been admitted to hospital for accidents and injuries, or have conditions such as asthma. We will try to work out the differences in these outcomes between the different groups of children, and what other risks (such as being born very early, or having a mother who smoked during pregnancy) are associated with these outcomes. The third stage of this study will look at the social work data on children born to mothers who used opioids in pregnancy. Many of these children will spend time living away from home, either with other family members or with foster carers. We will look at patterns of movement between different carers and what factors make a child more at risk of having different patterns of care away from home. We will then look at whether being cared for away from home leads to different health and developmental outcomes, compared with children who did not live away from home. Who will benefit?Our study findings will help a range of people and agencies in different ways. It will benefit women who use drugs and their children because it will help to show how practices and policies might better meet their needs. It will benefit society more widely as it will provide a better understanding of the everyday lives of parents and their families. It will also benefit professionals, services and policymakers by offering new understandings about what these families need to support them to give their children the best start in life. It will also advise on how we could collect better data on these families to improve services.