Kerry S Flannagan, Lindsey A Sjaarda, Sunni L Mumford, Enrique F Schisterman
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Although results of the studies suggest possible harms of short-term opioid use on fertility and pregnancy loss, methodologic limitations and the small number of studies make the literature inconclusive. This review highlights important data gaps that must be addressed to make conclusions about potential reproductive effects of short-term opioid use. These include the need for additional data on opioid use before clinically recognized pregnancy; accurate measurement of opioid exposure by multiple means with detailed information on the types and quantity of opioids used; assessment of important confounders, including opioid use indication, comorbidities, and use of other medications and substances; and studies of paternal opioid use, fertility, and pregnancy outcomes. A primary limitation of this review targeting studies of nonchronic opioid exposure is the possibility that selected studies included populations with unspecified chronic or dependent opioid use. 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引用次数: 3
摘要
处方阿片类药物的使用在育龄男性和女性中很常见,包括在辅助生殖过程中。阿片类药物使用障碍和慢性使用与生育和妊娠结局的危害有关,但尚不清楚这些关联是否延伸到处方阿片类药物使用的常见短期模式。我们使用PubMed、Embase、Web of Science和Scopus进行了文献综述,以确定非慢性、非依赖性阿片类药物使用和生殖终点的研究,包括生育力、妊娠丢失和妊娠并发症(即早产、出生体重、妊娠糖尿病和妊娠高血压疾病)。纳入了17项研究。虽然研究结果表明短期使用阿片类药物可能对生育和妊娠损失造成危害,但方法学的局限性和研究数量少使得文献不具有结论性。本综述强调了必须解决的重要数据缺口,以得出关于短期阿片类药物使用的潜在生殖影响的结论。其中包括需要在临床确认怀孕前获得阿片类药物使用的额外数据;通过多种手段准确测量阿片类药物暴露情况,并提供使用阿片类药物类型和数量的详细信息;评估重要混杂因素,包括阿片类药物使用指征、合并症和其他药物和物质的使用;以及父亲使用阿片类药物、生育能力和妊娠结局的研究。本综述针对非慢性阿片类药物暴露研究的主要局限性是所选研究可能包括未指明的慢性或依赖性阿片类药物使用人群。努力了解处方类阿片流行病的影响,应解决这些药物对育龄人群生殖的潜在危害。
Prescription Opioid Use Among Populations of Reproductive Age: Effects on Fertility, Pregnancy Loss, and Pregnancy Complications.
Prescription opioid use is common among men and women of reproductive age, including during assisted-reproduction procedures. Opioid use disorder and chronic use are associated with harms to fertility and pregnancy outcomes, but it is unclear whether these associations extend to common short-term patterns of prescription opioid use. We conducted a literature review using PubMed, Embase, Web of Science, and Scopus to identify studies of nonchronic, nondependent opioid use and reproductive endpoints including fertility, pregnancy loss, and pregnancy complications (i.e., preterm birth, birth weight, gestational diabetes, and hypertensive disorders of pregnancy). Seventeen studies were included. Although results of the studies suggest possible harms of short-term opioid use on fertility and pregnancy loss, methodologic limitations and the small number of studies make the literature inconclusive. This review highlights important data gaps that must be addressed to make conclusions about potential reproductive effects of short-term opioid use. These include the need for additional data on opioid use before clinically recognized pregnancy; accurate measurement of opioid exposure by multiple means with detailed information on the types and quantity of opioids used; assessment of important confounders, including opioid use indication, comorbidities, and use of other medications and substances; and studies of paternal opioid use, fertility, and pregnancy outcomes. A primary limitation of this review targeting studies of nonchronic opioid exposure is the possibility that selected studies included populations with unspecified chronic or dependent opioid use. Efforts to understand the impact of the prescription opioid epidemic should address potential reproductive harms of these medications among people of reproductive age.
期刊介绍:
Epidemiologic Reviews is a leading review journal in public health. Published once a year, issues collect review articles on a particular subject. Recent issues have focused on The Obesity Epidemic, Epidemiologic Research on Health Disparities, and Epidemiologic Approaches to Global Health.