背景:产前暴露于阿片类药物(PEO)是一个世界性的公共卫生问题。阿片类药物穿过胎盘屏障,可能会影响发育中的胎儿和分娩结局。
目的:这篇综述旨在探讨新生儿的体重,长度和头围,早产,围产期死亡是与PEO相关的主要结局。次要结果是出生时的胎龄,分娩后Apgar评分和住院时间。
方法:PubMed,Embase,PsycInfo和WebofScience。
方法:纳入标准是(i)队列,截至2021年3月1日以英文发表的病例对照或横断面同行评审研究;(ii)比较产前暴露和未暴露阿片类药物组(处方或非法获得)的结局.排除标准为胎儿酒精综合征和非阿片类药物初次暴露。
结果:数据由两位作者提取。纽卡斯尔-渥太华质量评估量表用于研究质量评估。由于不同研究的异质性,我们使用随机效应模型来获得合并的标准化平均差(SMD),合并风险比(RR)和95%置信区间(CI)。
结果:提取了80项研究的数据。在荟萃分析中,阿片类药物暴露的新生儿出生体重较低(SMD-0.77,95%CI-0.90,-0.64,I2=82%),头围较小(SMD-0.67,95%CI-0.86,-0.48,I2=84%),出生身长(SMD-0.97,95%CI-1.24,-0.70,I2=91%)和孕龄(SMD-0.45,95%CI-0.60,-0.30,I2=80%)比未暴露新生儿短。与未暴露的新生儿相比,阿片类药物暴露的新生儿死亡和早产的合并风险更高(RR4.05,95%CI2.12,7.72,I2=73%;RR1.92,95%CI1.57,2.35,I2=99%)。
结论:我们发现与PEO相关的不良分娩结局风险增加。在解释调查结果时应谨慎,由于许多研究被评为质量差,并具有实质性的研究间异质性。未来的研究应确保阿片类药物暴露组和未暴露组的可比性,以加强内部有效性。
BACKGROUND: Prenatal exposure to opioids (PEO) is a worldwide public health issue. Opioids cross the placental barrier and may affect the developing foetus and the birth outcomes.
OBJECTIVE: This
review aimed to explore newborns\' weight, length and head circumference, preterm birth, and perinatal death as primary outcomes in relation to PEO. The secondary outcomes were gestational age at birth, Apgar scores and length of hospitalisation after delivery.
METHODS: PubMed, Embase, PsycInfo and the Web of Science.
METHODS: Inclusion criteria were (i) cohort, case-control or cross-sectional peer-reviewed studies published in English through 1 March 2021; (ii) comparing outcomes between prenatal exposed and unexposed groups to opioids (prescribed or obtained illegally). Exclusion criteria were foetal alcohol syndrome and non-opioid primary exposure.
RESULTS: Data were extracted by two authors. The Newcastle-Ottawa Quality Assessment Scale was used for study quality assessment. Due to heterogeneity across studies, we used random effects models to obtain pooled standardised mean difference (SMD), pooled risk ratio (RR) and 95% confidence interval (CI).
RESULTS: Data from 80 studies were extracted. In meta-analyses, opioid-exposed neonates had lower birthweight (SMD -0.77, 95% CI -0.90, -0.64, I2 = 82%), smaller head circumference (SMD -0.67, 95% CI -0.86, -0.48, I2 = 84%), shorter birth length (SMD -0.97, 95% CI -1.24, -0.70, I2 = 91%) and gestational age (SMD -0.45, 95% CI -0.60, -0.30, I2 = 80%) than unexposed neonates. Pooled risks of neonatal death and preterm birth were higher among opioid-exposed compared to unexposed neonates (RR 4.05, 95% CI 2.12, 7.72, I2 = 73%; and RR 1.92, 95% CI 1.57, 2.35, I2 = 99%).
CONCLUSIONS: We found increased risks of adverse birth outcomes in relation to PEO. Caution should be used in interpreting the findings, as many studies were rated as poor quality, and with substantial inter-study heterogeneity. Future studies should ensure comparability of opioid-exposed and -unexposed group to strengthen internal validity.