Risk factors of overdose in maternal patients with opioid use disorder: a scoping review.

IF 2.7 3区 医学 Q2 PSYCHOLOGY, CLINICAL American Journal of Drug and Alcohol Abuse Pub Date : 2024-10-22 DOI:10.1080/00952990.2024.2407006
Kelly A Campbell, Anna L Wilson, Marilyn Torres, Neha Dantuluri, Kimberly Fryer
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Abstract

Background: Opioid-related overdoses significantly contribute to mortality in pregnancy and the postpartum period. Few studies report risk factors predisposing pregnant and postpartum patients with opioid use disorder (OUD) to overdose.Objective: This scoping review aims to describe the risk factors predisposing pregnant and postpartum patients with OUD to overdose.Method: Included studies identified pregnant and/or postpartum patients with OUD and differentiated between those who experienced overdose and those who did not. Of the 1060 articles, 8 met the criteria, examining 90,860 pregnant and postpartum patients with OUD.Results: Consistent use of medications for OUD (MOUD) during pregnancy and the postpartum period was the most frequently identified factor reducing overdose risk. Critical times of heightened overdose risk include the first trimester and the 7-12-month postpartum period. Pregnancy complications, such as stillbirth, severe maternal morbidity, preterm birth, and cesarean delivery, also increase risk. Opioid overdose is associated with being houseless, incarcerated, young, unmarried, publicly insured, not graduating high school, co-occurring substance use disorders, and inadequate prenatal care. Legislative changes, such as not classifying OUD in pregnancy as "child abuse" and increasing Medicaid reimbursement for Screening, Brief Intervention, and Referral to Treatment programs, are crucial to reducing risk. The impact of race and the influence of co-occurring psychiatric disorders was inconsistently reported.Conclusion: This scoping review identifies significant risk factors for opioid overdose in pregnant and postpartum patients. Improving access through enhanced Medicaid reimbursement, non-punitive reporting policies, and non-stigmatized care are keys to reducing overdose.

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患有阿片类药物使用障碍的产妇用药过量的风险因素:范围界定综述。
背景:与阿片类药物相关的用药过量是造成孕期和产后死亡的重要原因。很少有研究报告了阿片类药物使用障碍(OUD)孕妇和产后患者易发生用药过量的风险因素:本范围综述旨在描述妊娠期和产后阿片类药物滥用症患者易发生用药过量的风险因素:方法:纳入的研究确定了妊娠期和/或产后 OUD 患者,并对用药过量和未用药过量的患者进行了区分。在 1060 篇文章中,有 8 篇符合标准,对 90,860 名患有 OUD 的孕妇和产后患者进行了研究:结果:在怀孕期间和产后持续使用治疗 OUD 的药物(MOUD)是最常见的降低用药过量风险的因素。用药过量风险增加的关键时期包括妊娠头三个月和产后 7-12 个月。妊娠并发症,如死胎、严重的孕产妇发病率、早产和剖腹产也会增加风险。阿片类药物过量与无房、被监禁、年轻、未婚、有公共保险、高中未毕业、并发药物使用障碍和产前护理不足有关。立法变革对于降低风险至关重要,例如不将孕期 OUD 归为 "虐待儿童",增加医疗补助对筛查、简单干预和转诊治疗计划的报销。关于种族的影响以及并发精神疾病的影响的报告并不一致:此次范围界定审查确定了孕妇和产后患者阿片类药物过量的重要风险因素。通过加强医疗补助报销、非惩罚性报告政策和非污名化护理来改善获取途径是减少用药过量的关键。
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来源期刊
CiteScore
4.70
自引率
3.70%
发文量
68
期刊介绍: The American Journal of Drug and Alcohol Abuse (AJDAA) is an international journal published six times per year and provides an important and stimulating venue for the exchange of ideas between the researchers working in diverse areas, including public policy, epidemiology, neurobiology, and the treatment of addictive disorders. AJDAA includes a wide range of translational research, covering preclinical and clinical aspects of the field. AJDAA covers these topics with focused data presentations and authoritative reviews of timely developments in our field. Manuscripts exploring addictions other than substance use disorders are encouraged. Reviews and Perspectives of emerging fields are given priority consideration. Areas of particular interest include: public health policy; novel research methodologies; human and animal pharmacology; human translational studies, including neuroimaging; pharmacological and behavioral treatments; new modalities of care; molecular and family genetic studies; medicinal use of substances traditionally considered substances of abuse.
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