Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review

被引:103
作者
Lind, Jennifer N. [1 ,2 ]
Interrante, Julia D. [1 ,3 ]
Ailes, Elizabeth C. [1 ]
Gilboa, Suzanne M. [1 ]
Khan, Sara [1 ,4 ,5 ]
Frey, Meghan T. [1 ]
Dawson, April L. [1 ]
Honein, Margaret A. [1 ]
Dowling, Nicole F. [1 ]
Razzaghi, Hilda [1 ,2 ]
Creanga, Andreea A. [6 ,7 ]
Broussard, Cheryl S. [1 ]
机构
[1] Ctr Dis Control & Prevent, Natl Ctr Birth Defects & Dev Disabil, Div Congenital & Dev Disorders, Atlanta, GA USA
[2] US PHS, Atlanta, GA USA
[3] Oak Ridge Inst Sci & Educ, Oak Ridge, TN USA
[4] Emory Univ, Rollins Sch Publ Hlth, Dept Biostat & Bioinformat, Atlanta, GA 30322 USA
[5] Carter Consulting, Atlanta, GA USA
[6] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD USA
[7] Johns Hopkins Bloomberg Sch Publ Hlth, Int Ctr Maternal & Newborn Hlth, Baltimore, MD USA
关键词
NEONATAL ABSTINENCE SYNDROME; VITAL SIGNS OVERDOSES; ILLICIT DRUG-USE; UNITED-STATES; NARCOTIC ADDICTION; METHADONE-MAINTENANCE; PAIN RELIEVERS; PERINATAL OUTCOMES; EXPOSED CHILDREN; INFANT-MORTALITY;
D O I
10.1542/peds.2016-4131
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
CONTEXT: Opioid use and abuse have increased dramatically in recent years, particularly among women. OBJECTIVES: We conducted a systematic review to evaluate the association between prenatal opioid use and congenital malformations. DATA SOURCES: We searched Medline and Embase for studies published from 1946 to 2016 and reviewed reference lists to identify additional relevant studies. STUDY SELECTION: We included studies that were full-text journal articles and reported the results of original epidemiologic research on prenatal opioid exposure and congenital malformations. We assessed study eligibility in multiple phases using a standardized, duplicate review process. DATA EXTRACTION: Data on study characteristics, opioid exposure, timing of exposure during pregnancy, congenital malformations (collectively or as individual subtypes), length of follow-up, and main findings were extracted from eligible studies. RESULTS: Of the 68 studies that met our inclusion criteria, 46 had an unexposed comparison group; of those, 30 performed statistical tests to measure associations between maternal opioid use during pregnancy and congenital malformations. Seventeen of these (10 of 12 case-control and 7 of 18 cohort studies) documented statistically significant positive associations. Among the case-control studies, associations with oral clefts and ventricular septal defects/atrial septal defects were the most frequently reported specific malformations. Among the cohort studies, clubfoot was the most frequently reported specific malformation. LIMITATIONS: Variabilities in study design, poor study quality, and weaknesses with outcome and exposure measurement. CONCLUSIONS: Uncertainty remains regarding the teratogenicity of opioids; a careful assessment of risks and benefits is warranted when considering opioid treatment for women of reproductive age.
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页数:25
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