背景:怀孕期间阿片类药物使用障碍(OUD)对母体存在重大风险,胎儿,和新生儿健康,增加不良事件的可能性,比如产妇用药过量,怀孕失败,死产,早产,低出生体重,和新生儿禁欲综合征.为了降低这些结果的风险,在美国和加拿大的许多司法管辖区,OUD的孕期护理标准是阿片类药物激动剂治疗(OAT).OAT是指缓解或消除阿片类药物戒断症状的处方药,这样阿片类药物的使用可以更安全地管理。尽管OAT已被认为是OUD孕妇的安全选择,许多司法管辖区没有关于药物选择的治疗指南,给药建议,副作用管理,和个人偏好。目前缺乏关于不同OAT方案对妊娠结局影响的系统证据。
目的:我们旨在评估特定OAT药物对妊娠结局的影响,并为医生治疗OUD孕妇提供建议。
方法:MEDLINE,Embase,CINAHL,和PsycINFO数据库将搜索已发表的评估OAT个体妊娠结局的定量研究。鉴于早产的风险大大增加,低出生体重,小于胎龄,以及OUD孕妇的死产,这四个终点将构成我们的主要结局.数据库搜索将不受日期限制,会议摘要将限于过去两年。标题,摘要,全文将由两名审稿人独立筛选。数据将独立提取,一式两份,使用数据提取表格来降低审阅者偏见的风险。个别研究中的偏差风险将通过使用适当的CASP(关键评估技能计划)清单进行评估。对于考虑相同研究问题的研究,干预措施,或结果,将进行荟萃分析以综合汇总效应大小。如果研究不能直接比较,结果将在叙述性叙述中综合。研究之间的异质性将通过使用τ2统计量来衡量。如果有超过10项研究可用于汇总,发表偏倚将使用Egger回归检验进行评估。
结果:截至2023年1月,已确定总共3266篇摘要进行筛查。数据提取预计将于2023年2月开始。
结论:OAT及其对怀孕的影响是一个未被研究的领域,有可能改善健康结果,临床实践,教育,社区倡导。我们的审查结果将用于为临床实践指南提供信息,并改善孕妇的健康结果。调查结果将传播给不同的利益攸关方群体,包括政策制定者,临床医生,社区合作伙伴,和有吸毒经验的人。
背景:PROSPEROCRD42022332082;https://tinyurl.com/2p94pkx5。
■DERR1-10.2196/42417。
BACKGROUND: Opioid use disorder (OUD) during pregnancy presents a significant risk to maternal, fetal, and neonatal health, increasing the likelihood of adverse events, such as maternal overdose, pregnancy loss, stillbirth, preterm birth, low birth weight, and neonatal abstinence syndrome. In order to reduce the risk of these outcomes, the standard of care for OUD during pregnancy in many jurisdictions within the United States and Canada is opioid agonist therapy (OAT). OAT refers to prescription medications that alleviate or eliminate opioid withdrawal symptoms, so that opioid use can be managed more safely. Although OAT has been recognized as a safe option for pregnant people with OUD, many jurisdictions do not have treatment guidelines regarding pharmacological options, dosing recommendations, side effect management, and individual preferences. There is currently a lack of systematic evidence on the impacts of different OAT regimens on pregnancy outcomes.
OBJECTIVE: We aim to evaluate the impacts of specific OAT agents on pregnancy outcomes and inform recommendations for practitioners treating pregnant people with OUD.
METHODS: The MEDLINE, Embase, CINAHL, and PsycINFO databases will be searched for published quantitative studies assessing pregnancy outcomes for individuals on OAT. Given the substantially increased risk of preterm birth, low birth weight, small for gestational age, and stillbirth among pregnant people with OUD, these four end points will comprise our primary outcomes. Database searches will not be restricted by date, and conference abstracts will be restricted to the past 2 years. Titles, abstracts, and full-text articles will be independently screened by 2 reviewers.
Data will be extracted independently and in duplicate, using a
data extraction form to reduce the risk of reviewer bias. The risk of bias within individual studies will be assessed by using the appropriate CASP (Critical Appraisal Skills Programme) checklists. For studies that consider the same research questions, interventions, or outcomes, meta-analyses will be conducted to synthesize the pooled effect size. In the event that studies cannot be compared directly, results will be synthesized in a narrative account. Between-study heterogeneity will be measured by using the τ2 statistic. If more than 10 studies are available for pooling, publication bias will be evaluated by using the Egger regression test.
RESULTS: As of January 2023, a total of 3266 abstracts have been identified for screening.
Data extraction is expected to commence in February 2023.
CONCLUSIONS: The topic of OAT and its effect on pregnancy is an understudied area that has the potential to improve health outcomes, clinical practice, education, and community advocacy. The results of our
review will be used to inform clinical practice guidelines and improve health outcomes for pregnant people. Findings will be disseminated to diverse groups of stakeholders, including policy makers, clinicians, community partners, and individuals with lived experience of drug use.
BACKGROUND: PROSPERO CRD42022332082; https://tinyurl.com/2p94pkx5.
UNASSIGNED: DERR1-10.2196/42417.