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2018 ; 131
(5
): 803-814
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Opioid Detoxification During Pregnancy: A Systematic Review
#MMPMID29630016
Terplan M
; Laird HJ
; Hand DJ
; Wright TE
; Premkumar A
; Martin CE
; Meyer MC
; Jones HE
; Krans EE
Obstet Gynecol
2018[May]; 131
(5
): 803-814
PMID29630016
show ga
OBJECTIVE: To systematically review maternal and neonatal outcomes associated
with opioid detoxification during pregnancy. DATA SOURCES: PubMed, PsycINFO,
EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1,
1966, to September 1, 2016. METHODS OF STUDY SELECTION: English-language studies
that reported outcomes associated with opioid detoxification among pregnant women
with opioid use disorder were included. Nonoriginal research articles (case
reports, editorials, reviews) and studies that failed to report outcomes for
detoxification participants were excluded. Bias was assessed using the Cochrane
Collaboration's tool for assessing risk of bias and quality was assessed using
the U.S. Preventive Service Task Force Quality of Evidence scale. TABULATION,
INTEGRATION, AND RESULTS: Of 1,315 unique abstracts identified, 15 met criteria
for inclusion and included 1,997 participants, of whom 1,126 underwent
detoxification. Study quality ranged from fair to poor as a result of the lack of
a randomized control or comparison arm and high risk of bias across all studies.
Only nine studies had a comparison arm. Detoxification completion (9-100%) and
illicit drug relapse (0-100%) rates varied widely across studies depending on
whether data from participants who did not complete detoxification or who were
lost to follow-up were included in analyses. The reported rate of fetal loss was
similar among women who did (14 [1.2%]) and did not undergo detoxification (17
[2.0%]). CONCLUSIONS: Evidence does not support detoxification as a recommended
treatment intervention as a result of low detoxification completion rates, high
rates of relapse, and limited data regarding the effect of detoxification on
maternal and neonatal outcomes beyond delivery.
|*Opiate Substitution Treatment/adverse effects/methods/statistics & numerical
data
[MESH]