PDF(Pubmed)
Abstract：
Objective Buprenorphine is a commonly used medication to manage opioid use disorder, however there is limited data to guide induction protocols specifically during pregnancy. Similar to non-pregnant patients the Clinical Opiate Withdrawal Scale (COWS) is often used to guide induction and titration of buprenorphine in pregnancy. The objective of this retrospective descriptive study is to assess the inpatient buprenorphine induction patterns, treatment retention, and pregnancy outcomes among obstetric patients with opioid use disorder seeking treatment. Study design This was a retrospective study of obstetric patients with opioid use disorder admitted for inpatient buprenorphine induction at a large academic center between May 2015 to 2020. A descriptive analysis of the cohort, induction patterns, and dose retention after discharge were evaluated in addition to obstetric and neonatal outcomes. Results Sixty patients were admitted for inpatient buprenorphine induction at a median gestational age of 16.7 weeks. The median COWS score on presentation was 9. The starting dose for half of the patients (30 out of 60 patients) was 8 mg of buprenorphine, while 24 patients were started at 4 mg. The median duration of hospitalization was three days (range 2-12). The median buprenorphine dose upon discharge was 10 mg (range 4-20). Only 13 of the 35 patients (37%) who desired prenatal care at our institution returned to receive routine prenatal care. Of the 12 (20%) patients who delivered at our institution, nine were live births (75%). Among the live births, the median gestational age at delivery was 37.4 weeks, birth weight 3085 grams, and only one (8%) developed neonatal abstinence syndrome. Conclusion When using the Clinical Opiate Withdrawal Scale to guide inpatient buprenorphine titration for pregnant patients with opioid use disorder it takes approximately three days to establish a satisfactory maintenance dose with the median dose at discharge in this population being 10 mg. The majority of patients who followed up after hospital discharge did not need dose adjustments.
摘要：
目的丁丙诺啡是治疗阿片类药物使用障碍的常用药物,然而，只有有限的数据来指导妊娠期间的诱导方案。与非妊娠患者相似，临床阿片类药物戒断量表（COWS）通常用于指导妊娠中丁丙诺啡的诱导和滴定。这项回顾性描述性研究的目的是评估住院患者丁丙诺啡的诱导模式，治疗保留,阿片类药物使用障碍产科患者寻求治疗的妊娠结局。研究设计这是一项回顾性研究，对2015年5月至2020年期间在大型学术中心因服用丁丙诺啡而住院的阿片类药物使用障碍的产科患者进行了回顾性研究。对队列的描述性分析，感应模式，除产科和新生儿结局外，还评估出院后的剂量保留。结果60例住院患者均接受丁丙诺啡诱导，中位胎龄为16.7周。报告中的COWS评分中位数为9分。一半患者（60名患者中有30名）的起始剂量为8毫克丁丙诺啡，而24例患者开始服用4mg。中位住院时间为3天（范围2-12）。出院时的中位丁丙诺啡剂量为10mg（范围4-20）。在我们机构需要产前护理的35名患者中，只有13名（37％）返回接受常规产前护理。在我们机构分娩的12名(20%)患者中，9人是活产婴儿(75%)。在活产中，分娩时的中位胎龄为37.4周,出生体重3085克,只有1人(8%)出现新生儿禁欲综合征。结论当使用临床阿片类药物戒断量表指导患有阿片类药物使用障碍的妊娠患者的住院丁丙诺啡滴定时，需要大约三天的时间才能建立满意的维持剂量，该人群出院时的中位剂量为10mg。出院后随访的大多数患者不需要剂量调整。
