Maternal Use of Opioids During Pregnancy and Congenital Malformations: a Systematic Review
Maternal Use of Opioids During Jennifer N. Lind, PharmD, MPH, a, b Julia D. Interrante, MPH, a, c Elizabeth C. Ailes, PhD, MPH, a Suzanne M. Gilboa, PhD, a PregnancySara Khan, MSPH, a, d, e Meghan T. Frey, and MA, MPH, a CongenitalApril L. Dawson, MPH, a Margaret A. Honein, PhD, MPH, a a a, b f, g a Malformations:Nicole F. Dowling, PhD, Hilda Razzaghi, PhD, MSPH, A Andreea Systematic A. Creanga, MD, PhD, Cheryl Review S. Broussard, PhD CONTEXT: abstract Opioid use and abuse have increased dramatically in recent years, particularly OBJECTIVES: among women. We conducted a systematic review to evaluate the association between prenatal DATA SOURCES: opioid use and congenital malformations. We searched Medline and Embase for studies published from 1946 to 2016 and STUDY SELECTION: reviewed reference lists to identify additional relevant studies. 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, DATA EXTRACTION: duplicate review process. Data on study characteristics, opioid exposure, timing of exposure during pregnancy, congenital malformations (collectively or as individual subtypes), length of RESULTS: follow-up, and main findings were extracted from eligible studies. 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.
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