PDF(Pubmed)
Abstract：
BACKGROUND: Buprenorphine-naloxone treatment may confer substantial benefits for the treatment of opioid use disorder (OUD) during pregnancy including lower risk for overdose/death, less diversion potential and reduced use of other substances. Treatment may also result in less severe Neonatal Abstinence Syndrome (NAS), but little is known about the effects of this medication on fetal neurodevelopment.
METHODS: The purpose of the current study is to evaluate neurobehaviors among fetuses exposed to buprenorphine-naloxone at four time points over the second and third trimesters of gestation in pregnant women with OUD on buprenorphine-naloxone therapy. Sixty minutes of continuous fetal monitoring via fetal actocardiograph with a single wide array abdominal transducer took place at times of peak and trough buprenorphine-naloxone levels in 24 pregnant women. Data collection, which included measures of fetal heart rate and motor activity, was conducted between 24 and 36 weeks gestation, with the majority (84.6%) monitored at two or more gestational ages. Medication dose and other substance use was monitored throughout the study and infant NAS severity was assessed.
RESULTS: Fetal heart rate (FHR), FHR variability, accelerations in FHR, and motor activity were suppressed when buprenorphine-naloxone levels were at pharmacologic peak as compared to trough concentrations at 36 weeks, but not earlier in gestation. Maternal medication dose was unrelated to infant NAS severity.
CONCLUSIONS: Conclusions: There were evident subclinical fetal neurophysiological responses at times of peak maternal buprenorphine/naloxone levels in later gestation, similar to those previously described for buprenorphine only. Further studies evaluating the effects of these changes in fetal neurobehaviors on the longer-term infant development are needed.
METHODS: The purpose of the current study is to evaluate neurobehaviors among fetuses exposed to buprenorphine-naloxone at four time points over the second and third trimesters of gestation in pregnant women with OUD on buprenorphine-naloxone therapy. Sixty minutes of continuous fetal monitoring via fetal actocardiograph with a single wide array abdominal transducer took place at times of peak and trough buprenorphine-naloxone levels in 24 pregnant women. Data collection, which included measures of fetal heart rate and motor activity, was conducted between 24 and 36 weeks gestation, with the majority (84.6%) monitored at two or more gestational ages. Medication dose and other substance use was monitored throughout the study and infant NAS severity was assessed.
RESULTS: Fetal heart rate (FHR), FHR variability, accelerations in FHR, and motor activity were suppressed when buprenorphine-naloxone levels were at pharmacologic peak as compared to trough concentrations at 36 weeks, but not earlier in gestation. Maternal medication dose was unrelated to infant NAS severity.
CONCLUSIONS: Conclusions: There were evident subclinical fetal neurophysiological responses at times of peak maternal buprenorphine/naloxone levels in later gestation, similar to those previously described for buprenorphine only. Further studies evaluating the effects of these changes in fetal neurobehaviors on the longer-term infant development are needed.
摘要：
背景：丁丙诺啡-纳洛酮治疗可能为妊娠期阿片类药物使用障碍（OUD）的治疗带来实质性益处，包括降低过量/死亡的风险，减少了转移潜力，减少了其他物质的使用。治疗也可能导致不太严重的新生儿禁欲综合征（NAS），但对这种药物对胎儿神经发育的影响知之甚少。
方法：本研究的目的是评估接受丁丙诺啡-纳洛酮治疗的OUD孕妇在妊娠第二和第三个三个月暴露于丁丙诺啡-纳洛酮的胎儿的神经行为。在24名孕妇中，丁丙诺啡-纳洛酮水平达到峰值和谷值时，通过带有单个宽阵列腹部换能器的胎儿心电描记器进行了60分钟的连续胎儿监测。.数据收集,包括测量胎儿心率和运动活动，在妊娠24到36周之间进行，大多数(84.6%)在两个或两个以上胎龄进行监测。在整个研究过程中监测药物剂量和其他物质的使用，并评估婴儿NAS的严重程度。
结果：胎儿心率（FHR），FHR变异性,FHR中的加速度，与36周时的谷浓度相比，当丁丙诺啡-纳洛酮水平处于药理学峰值时，运动活动受到抑制，但不是在妊娠早期。产妇用药剂量与婴儿NAS严重程度无关。
结论：结论：妊娠后期母体丁丙诺啡/纳洛酮峰值时，胎儿有明显的亚临床神经生理反应，类似于以前描述的丁丙诺啡。需要进一步研究评估胎儿神经行为的这些变化对婴儿长期发育的影响。
方法：本研究的目的是评估接受丁丙诺啡-纳洛酮治疗的OUD孕妇在妊娠第二和第三个三个月暴露于丁丙诺啡-纳洛酮的胎儿的神经行为。在24名孕妇中，丁丙诺啡-纳洛酮水平达到峰值和谷值时，通过带有单个宽阵列腹部换能器的胎儿心电描记器进行了60分钟的连续胎儿监测。.数据收集,包括测量胎儿心率和运动活动，在妊娠24到36周之间进行，大多数(84.6%)在两个或两个以上胎龄进行监测。在整个研究过程中监测药物剂量和其他物质的使用，并评估婴儿NAS的严重程度。
结果：胎儿心率（FHR），FHR变异性,FHR中的加速度，与36周时的谷浓度相比，当丁丙诺啡-纳洛酮水平处于药理学峰值时，运动活动受到抑制，但不是在妊娠早期。产妇用药剂量与婴儿NAS严重程度无关。
结论：结论：妊娠后期母体丁丙诺啡/纳洛酮峰值时，胎儿有明显的亚临床神经生理反应，类似于以前描述的丁丙诺啡。需要进一步研究评估胎儿神经行为的这些变化对婴儿长期发育的影响。
