丁丙诺啡-纳洛酮与丁丙诺啡治疗妊娠期阿片类药物使用障碍：一项系统综述和荟萃分析

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-02-28 DOI:10.1016/j.drugalcdep.2025.112632

Fernanda Ribeiro de Lima , Gabriela Oliveira Gonçalves Molino , Mariano Gallo Ruelas , Eduardo Cerchi Barbosa , Pedro Henrique Costa Matos da Silva , Felipe Bandeira de Melo Guimarães , Arthur Bezerra Cavalcanti Petrucci , Giovanna Hanike Santos da Silva , Ângelo Eduardo Espíndola Sbardelotto , Saulo Bernardo Lança , Alicja Garbacka

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引用次数: 0

摘要

背景：治疗妊娠期间阿片类药物使用障碍（OUD）的护理标准包括丁丙诺啡或美沙酮。虽然丁丙诺啡-纳洛酮因误用风险降低而成为一种替代药物，但关于其对妊娠和婴儿健康影响的证据仍然有限。本系统综述和荟萃分析旨在比较丁丙诺啡-纳洛酮与单用丁丙诺啡治疗妊娠期OUD的效果，评估妊娠期和新生儿结局。方法系统检索MEDLINE、Embase和Cochrane图书馆数据库，找出比较丁丙诺啡-纳洛酮与丁丙诺啡治疗妊娠期OUD的研究。评估的主要结局是新生儿戒断综合征（NAS）。采用R统计软件计算合并风险比（RR）和95%置信区间（CI）的平均差异（MD），并按照Cochrane推荐进行质量评估。结果纳入6组回顾性队列，共9348对母婴，其中38.3%的母婴接受丁丙诺啡-纳洛酮治疗。NAS需要治疗(RR 0.77；95% ci 0.71-0.84；p < 0.01)，小于胎龄儿(RR 0.86；95% ci 0.76-0.98；P = 0.03)，丁丙诺啡-纳洛酮组的发生率明显降低。剖宫产组间差异无统计学意义(RR 1.04；95% ci 0.98-1.11；p = 0.20)，低出生体重(RR 1.07；95% ci 0.91-1.24；p = 0.41)和早产(RR 1.07；95% ci 0.96-1.21；p = 0.22)。结论孕妇接受丁丙诺啡-纳洛酮治疗，新生儿低胎龄和NAS风险较低。需要进一步的研究来证实这些发现，并探索其他妊娠相关和新生儿结局。

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Buprenorphine-naloxone versus buprenorphine for opioid use disorder during pregnancy: A systematic review and meta-analysis

Background

The standard of care for treating opioid use disorder (OUD) during pregnancy includes either buprenorphine or methadone. Although buprenorphine-naloxone presents an alternative due to the reduced risk of misuse , evidence regarding its impact on pregnancy and infant health remains limited. This systematic review and meta-analysis aims to compare buprenorphine-naloxone vs buprenorphine alone for OUD during pregnancy, assessing gestational and neonatal outcomes.

Methods

We systematically searched MEDLINE, Embase, and Cochrane Library databases to identify studies comparing buprenorphine-naloxone versus buprenorphine for OUD during pregnancy. The primary outcome assessed was neonatal abstinence syndrome (NAS). Pooled risk ratios (RR) and mean differences (MD) with 95 % confidence intervals (CI) were calculated using R statistical software and quality assessment was performed following Cochrane recommendations.

Results

Six retrospective cohorts were included, encompassing 9348 mother-infant dyads, of whom 38.3 % received buprenorphine-naloxone. NAS requiring treatment (RR 0.77; 95 % CI 0.71–0.84; p < 0.01) and small for gestational age infants (RR 0.86; 95 % CI 0.76–0.98; p = 0.03) were significantly less frequent in the buprenorphine-naloxone group. No significant differences were found between the groups for cesarean delivery (RR 1.04; 95 % CI 0.98–1.11; p = 0.20), low birth weight (RR 1.07; 95 % CI 0.91–1.24; p = 0.41), and preterm delivery (RR 1.07; 95 % CI 0.96–1.21; p = 0.22).

Conclusion

Pregnant people treated with buprenorphine-naloxone had neonates with a lower risk of small for gestational age and NAS. Further research is needed to confirm these findings and explore other pregnancy-related and neonatal outcomes.

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.