本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-077664

摘要内容如下：

客观

研究产前阿片类药物暴露与儿童神经精神疾病风险之间的潜在联系。

设计

全国出生队列研究。

设置

从2009年1月1日至2020年12月31日，收集了韩国国家健康保险服务中与活产婴儿相关的韩国孕妇的出生队列数据。

参与者

所有3251594名婴儿（配对母亲，n=2369322；年龄32.1岁（标准差4.2）），并从出生之日至死亡之日或2020年12月31日进行随访。

主要结果指标

患有精神和行为障碍的活产婴儿的神经精神障碍诊断（国际疾病分类第10版编码F00-99）。随访持续至首次诊断为神经精神障碍，即2020年12月31日（研究期结束）或死亡日期，以先发生者为准。创建了8个队列：形成了3个队列（完全不匹配队列、倾向评分匹配队列和儿童筛查队列），所有这些队列都与同胞比较队列配对，此外还有两个倾向评分组。进行了多个亚组分析。

结果

在纳入的3128571名婴儿（来自2299664名母亲）中，我们确定了2912559名（51.3%为男性，48.7%为女性）产前无阿片类药物暴露的婴儿和216012名（51.2%为男性，48.8%为女性）产前有阿片类药物暴露的婴儿。在匹配队列中，产前暴露于阿片类药物的儿童神经精神疾病的风险为1.07（95%置信区间1.05至1.10），但在同胞比较队列中未发现显著相关性（风险比1.00（0.93至1.07））。妊娠前三个月的产前阿片类药物暴露（1.11（1.07至1.15））、较高的阿片类药物剂量（1.15（1.09至1.21））和60天或更长时间的长期阿片类药物使用（1.95（1.24至3.06））与儿童神经精神疾病的风险增加相关。产前阿片类药物暴露适度增加了儿童严重神经精神障碍（1.30（1.15至1.46））、情绪障碍、注意缺陷多动障碍和智力残疾的风险。

结论

怀孕期间使用阿片类药物与后代神经精神疾病风险的显著增加无关。观察到神经精神疾病的风险略有增加，但鉴于该研究的观察性质，这不应被视为具有临床意义，并且仅限于高阿片类药物剂量、使用一种以上阿片类药物、暴露时间较长、妊娠早期阿片类药物暴露以及某些神经精神疾病。

英文原文如下：

Abstracts

OBJECTIVE  To investigate the potential association between prenatal opioid exposure and the risk of neuropsychiatric disorders in children.

DESIGN  Nationwide birth cohort study.

SETTING  From 1 January 2009 to 31 December 2020, birth cohort data of pregnant women in South Korea linked to their liveborn infants from the National Health Insurance Service of South Korea were collected.

PARTICIPANTS  All 3 251 594 infants (paired mothers, n=2 369 322; age 32.1 years (standard deviation 4.2)) in South Korea from the start of 2010 to the end of 2017, with follow-up from the date of birth until the date of death or 31 December 2020, were included.

MAIN OUTCOME MEASURES  Diagnosis of neuropsychiatric disorders in liveborn infants with mental and behaviour disorders (International Classification of Diseases 10th edition codes F00-99). Follow-up continued until the first diagnosis of neuropsychiatric disorder, 31 December 2020 (end of the study period), or the date of death, whichever occurred first. Eight cohorts were created: three cohorts (full unmatched, propensity score matched, and child screening cohorts) were formed, all of which were paired with sibling comparison cohorts, in addition to two more propensity score groups. Multiple subgroup analyses were performed.

RESULTS  Of the 3 128 571 infants included (from 2 299 664 mothers), we identified 2 912 559 (51.3% male, 48.7% female) infants with no prenatal opioid exposure and 216 012 (51.2% male, 48.8% female) infants with prenatal opioid exposure. The risk of neuropsychiatric disorders in the child with prenatal opioid exposure was 1.07 (95% confidence interval 1.05 to 1.10) for fully adjusted hazard ratio in the matched cohort, but no significant association was noted in the sibling comparison cohort (hazard ratio 1.00 (0.93 to 1.07)). Prenatal opioid exposure during the first trimester (1.11 (1.07 to 1.15)), higher opioid doses (1.15 (1.09 to 1.21)), and long term opioid use of 60 days or more (1.95 (1.24 to 3.06)) were associated with an increased risk of neuropsychiatric disorders in the child. Prenatal opioid exposure modestly increased the risk of severe neuropsychiatric disorders (1.30 (1.15 to 1.46)), mood disorders, attention deficit hyperactivity disorder, and intellectual disability in the child.

CONCLUSIONS  Opioid use during pregnancy was not associated with a substantial increase in the risk of neuropsychiatric disorders in the offspring. A slightly increased risk of neuropsychiatric disorders was observed, but this should not be considered clinically meaningful given the observational nature of the study, and limited to high opioid dose, more than one opioid used, longer duration of exposure, opioid exposure during early pregnancy, and only to some neuropsychiatric disorders.

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