Improving outcomes for children exposed to opioids in pregnancy across the world: an international longitudinal administrative data study

在世界范围内，阿片类药物的使用（如海洛因）现在被视为一种“危机”。男性更有可能使用阿片类药物，但近年来，使用阿片类药物的女性人数有所增加。因此，使用阿片类药物的怀孕人数也在增加。已经有强有力的证据表明，在怀孕期间使用阿片类药物会损害未出生的孩子，但对这些孩子的长期结果知之甚少：由于他们生活的复杂性，很难使用传统方法对他们进行长时间的随访，例如反复的面对面访谈。苏格兰处于一种罕见的地位，能够将一个人一生中的所有健康数据联系起来，并将母亲和儿童的数据联系起来，这些数据在所有国家都不容易获得，而且阿片类药物的使用率很高。作为第一步，我已经表明，我们可以从我们已经在苏格兰常规收集的健康数据（例如产前记录、医院记录）中确定在怀孕期间使用非法或处方阿片类药物的妇女，并且可以将其与其子女的等效数据相匹配。这为我们提供了一种探索长期结果的方法。拟议的研究将首次分析以人群为基础的从怀孕到青春期接触阿片类药物的儿童队列。这将使我们能够探索苏格兰儿童的一系列健康、教育和司法成果，并探索他们实现这些成果的途径。通过母亲的物质使用而暴露于阿片类药物的儿童的结果将与其他两组儿童进行比较：1)在怀孕期间使用阿片类药物治疗慢性疼痛的母亲，以及2)来自相似社会经济背景但未暴露于阿片类药物的儿童。我们也不太清楚药物是如何在怀孕期间传递给未出生的孩子的，因为对孩子的影响似乎与母亲的消费没有直接联系。我将与法医化学家合作开发一种根据血液样本中检测到的药物（如海洛因、吗啡、美沙酮）的类型和数量改变颜色的测试。在第一阶段，将使用动物血液进行开发。在第二阶段，我们计划对从脐带采集的血液进行测试。在第一阶段，我将与使用阿片类药物的母亲合作，收集关于她们对使用脐带血的看法和潜在担忧的信息，以确保这项研究在第二阶段敏感地进行。还有一些国家拥有优秀的数据链接系统，但在怀孕期间接触阿片类药物的婴儿数量较少。本研究的第二阶段将是发展国际合作，以便访问来自一些斯堪的纳维亚和英联邦国家（新西兰，澳大利亚）的数据集，并在这些国际数据集上测试苏格兰数据上发现的路径。在英国其他地区，很难像苏格兰那样将数据整合到一起。因此，我们将与其他英国国家合作，改善这些数据联系。这将意味着，在研究的后期，我们可以用与苏格兰数据类似的方式分析整个英国的数据。在整个项目中，我们将与使用阿片类药物的妇女、母亲使用阿片类药物的年轻人以及支持这些家庭的慈善组织和政策制定者合作。这将确保我们提出正确的问题，并能够为未来的研究和干预创造有用和有意义的建议。这项研究的结果将有助于我们了解怀孕期间使用阿片类药物对儿童的影响，并使我们能够探索有希望的干预方法，以改善目前向妇女、收养家庭及其子女提供的支持。我们的研究结果将确保世界各地的女性获得有关阿片类药物在怀孕期间使用影响的准确信息，以帮助她们的孩子拥有最好的人生开端。

Worldwide, opioid use (e.g. heroin) is now viewed as a 'crisis'. Men are more likely to use opioids, but in recent years there has been a greater increase in the numbers of women using opioids. As a consequence, the numbers of pregnancies where opioid use is a factor is also increasing. There is already strong evidence that opioid use in pregnancy harms the unborn child, but very little is known about the long-term outcomes for these children: they are difficult to follow-up over a long time period using traditional methods, such as repeated face-to-face interviews, due to the complexity of their lives. Scotland is in a rare position of being able to link all health data across a person's lifetime, as well as linking mother and child data, not readily available in all countries, and having high levels of opioid use. As a first step, I have shown that we can identify women who use illicit or prescription opioids in pregnancy from the health data we already collect routinely (e.g. antenatal records, hospital records) in Scotland and this can be matched to equivalent data from their children. This gives us a way of exploring longer term outcomes. The proposed research will be the first to analyse a population-based cohort of children exposed to opioids in pregnancy through to adolescence. This will allow us to explore a range of health, education and justice outcomes for children in Scotland, and to explore the pathways they take to these outcomes. The outcomes of children who were exposed to opioids through their mother's substance use will be compared with children in two other groups: 1) mothers who used opioids for chronic pain in pregnancy, and 2) children who are from similar socio-economic backgrounds but who were not exposed to opioids. We also don't know much about how drugs pass through to the unborn child during pregnancy, as the effects on the child do not seem to be directly linked to the mother's consumption. I will work with a forensic chemist to develop a test which changes colour depending on the type and amount of drugs (e.g. heroin, morphine, methadone) detected in blood samples. In Phase 1 this will be developed using animal bloods. In phase 2 we plan to test this on blood collected from the umbilical cord. During Phase 1 I will work with mothers who use opioids to gather information on their views and potential concerns around the use of cord blood, in order to ensure this research is conducted sensitively in Phase 2. There are other countries with excellent data linkage systems, but with smaller numbers of babies exposed to opioids in pregnancy. The second stage of this study will be to develop international collaborations, in order to access datasets from some Scandinavian and Commonwealth countries (New Zealand, Australia) and to test the pathways found on the Scottish data on these international datasets. In the rest of the UK, it is difficult to bring data together to the same degree as in Scotland. We will therefore work with other UK nations to improve these data linkages. This will mean that later in the study we can analyse data for the whole of the UK in a similar way to the Scottish data.Throughout the project we will work with women who use opioids, young adults whose mothers used opioids, and the charity organisations and policy-makers who support these families. This will ensure that we are asking the right questions and will be able to create useful and meaningful recommendations for future research and intervention.The results of this study will help us to understand the effects on children of opioid use during pregnancy and allow us to explore promising approaches for interventions to improve the support that is currently provided to women, adoptive families, and their children. Our findings will ensure that women across the world are given accurate information about the impact of opioid use in pregnancy to help provide their children with the best start in life.