Distinct Trajectories of Prescription Opioid Exposure in Pregnancy and Risk of Adverse Birth Outcomes.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE
Yi Wang, Deborah B Ehrenthal, Liwei Zhang
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引用次数: 0

Abstract

Objectives: The aim of this study was to identify distinct trajectories of prescription opioid exposure in pregnancy-encompassing both medication for opioid use disorder (MOUD) and opioid analgesics-and explore their associations with birth outcomes.

Methods: Trajectories were identified using latent class analysis among Wisconsin Medicaid-insured live births 2011-2019. Logistic regression estimated associations between these trajectories and neonatal opioid withdrawal syndrome (NOWS), small for gestational age, preterm birth, birth weight, and gestational age.

Results: Of 138,123 births, 27,293 (19.8%) had prenatal opioid exposure. Five trajectory classes were identified: (1) stable MOUD treatment (5.8%), (2) inconsistent MOUD treatment (3.9%), (3) chronic analgesic use (4.2%), (4) intermittent analgesic use (7.8%), and (5) low-level use of MOUD and analgesics (78.3%). NOWS incidence per 1000 infants was 667 for class 1 (adjusted odds ratio [aOR]: 21.74, 95% confidence interval [CI]: 17.89, 26.41), 570 for class 2 (aOR: 15.35, 95% CI: 12.49, 18.87), 235 for class 3 (aOR: 19.42, 95% CI: 15.93, 23.68), 67 for class 4 (aOR: 6.23, 95% CI: 4.99, 7.76), and 12 for class 5 (aOR: 1.73, 95% CI: 1.47, 2.02). Classes 1-4 had elevated risk of small for gestational age, preterm birth, lower birth weight, and shorter gestational age, with no significant differences among these classes. Among individuals with opioid use disorder, stable MOUD treatment was associated with higher birth weights and longer gestational ages compared to inconsistent treatment, despite higher odds of NOWS.

Conclusions: Early initiation and consistent MOUD treatment may improve birth weight and gestational age. For pregnant individuals with opioid use disorder using chronic analgesics, transition to MOUD may promote birth outcomes.

妊娠期处方类阿片暴露的不同轨迹与不良出生结果的风险。
研究目的本研究旨在确定孕期处方阿片类药物暴露的不同轨迹(包括阿片类药物使用障碍(MOUD)和阿片类镇痛药),并探讨其与分娩结局的关联:在 2011-2019 年威斯康星州医疗补助参保的活产婴儿中,采用潜类分析法确定了这些轨迹。逻辑回归估计了这些轨迹与新生儿阿片类药物戒断综合征(NOWS)、小胎龄、早产、出生体重和胎龄之间的关联:在 138 123 名新生儿中,有 27 293 名(19.8%)在产前接触过阿片类药物。确定了五个轨迹等级:(1)稳定的 MOUD 治疗(5.8%);(2)不稳定的 MOUD 治疗(3.9%);(3)长期使用镇痛剂(4.2%);(4)间歇性使用镇痛剂(7.8%);(5)低水平使用 MOUD 和镇痛剂(78.3%)。每 1000 名婴儿中,1 级 NOWS 发生率为 667(调整后的几率比 [aOR]:21.74,95% 置信区间 [CI]:17.89, 26.41):2级为570例(aOR:15.35,95% CI:12.49,18.87),3级为235例(aOR:19.42,95% CI:15.93,23.68),4级为67例(aOR:6.23,95% CI:4.99,7.76),5级为12例(aOR:1.73,95% CI:1.47,2.02)。1-4 级的胎龄小、早产、出生体重较轻和胎龄较短的风险较高,各等级之间无显著差异。在阿片类药物使用障碍患者中,尽管NOWS的几率较高,但与不稳定的治疗相比,稳定的MOUD治疗与较高的出生体重和较长的胎龄相关:结论:及早开始并持续进行 MOUD 治疗可改善出生体重和胎龄。对于患有阿片类药物使用障碍、长期使用镇痛药的孕妇来说,过渡到 "钼靶治疗 "可能会改善出生结果。
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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