加拿大多伦多新宁医院Jonathan S Zipursky团队研究了产妇分娩后阿片类药物治疗与婴儿不良结局的风险关联。2023年3月15日出版的《英国医学杂志》发表了这项成果。

为了研究产妇产后阿片类药物治疗是否与婴儿不良结局风险增加有关，研究组在加拿大安大略省进行了一项基于人群的队列研究，招募2012年9月1日至2020年3月31日分娩后7天内活着出院的865691对母婴。每一位在出院后七天内开具阿片类药物处方的母亲倾向得分都与一位没有开具处方的母亲相匹配。主要结局是婴儿在母亲开具阿片类药物处方后30天内因任何原因再次入院（指标日期）。与婴儿相关的次要结局是任何急诊科就诊、全因受伤入院、入住新生儿重症监护室、接受复苏或辅助通气入院以及全因死亡。

85675名母亲（在85852名开具阿片类药物处方的母亲中占99.8%）在产后出院七天内开具了阿片类处方，其倾向得分与85675名未开具阿片类药物处方的女性相匹配。在30天内入院的婴儿中，2962名（3.5%）的母亲服用阿片类药物处方，而3038名（3.5%）的母亲未服用阿片药物处方。服用阿片类药物母亲的婴儿因任何原因入院的可能性并不比未服用阿片类药物母亲的婴儿高（危险比为0.98），在随后的30天内被送往急诊科的可能性略高（危险比为1.04），但未发现任何其他不良婴儿结局的差异，也没有婴儿死亡。

这项研究的结果表明，产妇产后阿片类药物处方与包括死亡在内的不良婴儿结局之间没有关联。

附：英文原文

Title: Maternal opioid treatment after delivery and risk of adverse infant outcomes: population based cohort study

Author: Jonathan S Zipursky, Tara Gomes, Karl Everett, Andrew Calzavara, J Michael Paterson, Peter C Austin, Muhammad M Mamdani, Joel G Ray, David N Juurlink

Issue&Volume: 2023/03/15

Abstract:

Objective To examine whether maternal opioid treatment after delivery is associated with an increased risk of adverse infant outcomes.

Design Population based cohort study.

Setting Ontario, Canada.

Participants 865691 mother-infant pairs discharged from hospital alive within seven days of delivery from 1 September 2012 to 31 March 2020. Each mother who filled an opioid prescription within seven days of discharge was propensity score matched to a mother who did not.

Main outcome measures The primary outcome was hospital readmission of infants for any reason within 30 days of their mother filling an opioid prescription (index date). Infant related secondary outcomes were any emergency department visit, hospital admission for all cause injury, admission to a neonatal intensive care unit, admission with resuscitation or assisted ventilation, and all cause death.

Results 85675 mothers (99.8% of the 85852 mothers prescribed an opioid) who filled an opioid prescription within seven days of discharge after delivery were propensity score matched to 85675 mothers who did not. Of the infants admitted to hospital within 30 days, 2962 (3.5%) were born to mothers who filled an opioid prescription compared with 3038 (3.5%) born to mothers who did not. Infants of mothers who were prescribed an opioid were no more likely to be admitted to hospital for any reason than infants of mothers who were not prescribed an opioid (hazard ratio 0.98, 95% confidence interval 0.93 to 1.03) and marginally more likely to be taken to an emergency department in the subsequent 30 days (1.04, 1.01 to 1.08), but no differences were found for any other adverse infant outcomes and there were no infant deaths.

Conclusions Findings from this study suggest no association between maternal opioid prescription after delivery and adverse infant outcomes, including death.

DOI: 10.1136/bmj-2022-074005

Source: https://www.bmj.com/content/380/bmj-2022-074005