接受阿片类药物使用障碍药物治疗的女性的妊娠率。
Pregnancy Rates Among Women Treated with Medication for Opioid Use Disorder.
机构信息
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
Health and Behavior Research Center, Division of Addiction Science, Prevention and Treatment, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
出版信息
J Gen Intern Med. 2024 Jun;39(8):1342-1348. doi: 10.1007/s11606-024-08689-8. Epub 2024 Feb 29.
BACKGROUND
Treatment-seeking people with opioid use disorder (OUD) who are capable of pregnancy need accurate information about the potential impact of medication to treat OUD (MOUD) on fertility to make informed choices about treatment that are consistent with their reproductive wishes. There is a dearth of research on fertility associated with MOUD receipt in birthing people with OUD.
OBJECTIVE
To estimate the association between treatment with MOUD and odds of conception among birthing people using national administrative claims.
DESIGN
Retrospective case-crossover study using multi-state US administrative data (2006-2016). Dates of conception were estimated from delivery dates and served as "case" days for which MOUD exposures were compared to those on all other ("control") days of insurance enrollment.
PARTICIPANTS
Treatment-seeking people with OUD with a delivery during the observation period.
MAIN MEASURES
Odds ratios for conception from within-person fixed effects models were modeled as a function of exposure to MOUD (buprenorphine, methadone, extended-release depot naltrexone, or oral naltrexone) using conditional logistic regression.
KEY RESULTS
A total of 21,928 births among 19,133 people with OUD were identified. In the sample, 5873 people received buprenorphine, 1825 methadone, 486 extended-release naltrexone, and 714 oral naltrexone. Participants could receive more than one type of MOUD. Mean age was 28.2 years (SD = 2.2; range = 16-45), with 76.2% having Medicaid. vs. commercial insurance. Compared to no MOUD, periods of methadone (aOR = 0.55 [95% CI = 0.48-0.63]) or buprenorphine receipt (aOR = 0.84 [0.77-0.91]) were associated with fewer conceptions. Treatment periods with extended-release depot naltrexone compared to no medication were associated with higher odds of conception (aOR = 1.75 [1.22-2.50]) and there was no significant difference in conception with oral naltrexone (aOR = 1.02 [0.67-1.54]).
CONCLUSIONS
The association between MOUD and odds of conception among birthing people varied by type of MOUD, with extended-release naltrexone associated with higher odds of conceiving compared to no treatment. Clinical studies are urgently needed to investigate these findings further.
背景
有药物滥用障碍（OUD）且有生育能力的寻求治疗的患者需要准确了解治疗 OUD 的药物（MOUD）对生育能力的潜在影响，以便做出符合其生育愿望的治疗选择。在有 OUD 的产妇中，与 MOUD 治疗相关的生育能力研究很少。
目的
使用全国行政索赔数据估计 MOUD 治疗与产妇受孕几率之间的关联。
设计
使用多状态美国行政数据的回顾性病例交叉研究（2006-2016 年）。受孕日期是根据分娩日期估计的，作为“病例”日，在此期间比较 MOUD 暴露与保险登记期间所有其他（“对照”）日的暴露情况。
参与者
在观察期间分娩的有 OUD 且寻求治疗的患者。
主要措施
使用条件逻辑回归，将个体内固定效应模型中的受孕几率比值作为 MOUD（丁丙诺啡、美沙酮、纳曲酮长效缓释片或口服纳曲酮）暴露的函数进行建模。
主要结果
在 19133 名有 OUD 的患者中，共确定了 21928 例分娩。在样本中，5873 人接受了丁丙诺啡，1825 人接受了美沙酮，486 人接受了纳曲酮长效缓释片，714 人接受了口服纳曲酮。参与者可能会接受不止一种类型的 MOUD。平均年龄为 28.2 岁（SD=2.2；范围为 16-45），76.2%的人有医疗补助。而商业保险。与无 MOUD 相比，美沙酮（aOR=0.55[95%CI=0.48-0.63]）或丁丙诺啡（aOR=0.84[0.77-0.91]）治疗期间受孕的几率较低。与无药物治疗相比，接受纳曲酮长效缓释片治疗的时期与受孕几率较高相关（aOR=1.75[1.22-2.50]），而口服纳曲酮（aOR=1.02[0.67-1.54]）与受孕几率无显著差异。
结论
在有生育能力的产妇中，MOUD 与受孕几率的关联因 MOUD 类型而异，与无治疗相比，纳曲酮长效缓释片与较高的受孕几率相关。迫切需要开展临床研究进一步调查这些发现。
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