Improving outcomes for children exposed to opioids in pregnancy across the world: an international longitudinal administrative data study

改善世界各地妊娠期间接触阿片类药物的儿童的结局：一项国际纵向管理数据研究

• 批准号: MR/X035638/1
• 负责人: Louise Marryat
• 金额: $ 174.04万
• 依托单位: University of Dundee
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FX035638%2F1
• 关键词: Improving; outcomes; children; exposed; opioids

Worldwide, opioid use (e.g. heroin) is now viewed as a 'crisis'. Men are more likely to use opioids, but in recent years there has been a greater increase in the numbers of women using opioids. As a consequence, the numbers of pregnancies where opioid use is a factor is also increasing. There is already strong evidence that opioid use in pregnancy harms the unborn child, but very little is known about the long-term outcomes for these children: they are difficult to follow-up over a long time period using traditional methods, such as repeated face-to-face interviews, due to the complexity of their lives. Scotland is in a rare position of being able to link all health data across a person's lifetime, as well as linking mother and child data, not readily available in all countries, and having high levels of opioid use. As a first step, I have shown that we can identify women who use illicit or prescription opioids in pregnancy from the health data we already collect routinely (e.g. antenatal records, hospital records) in Scotland and this can be matched to equivalent data from their children. This gives us a way of exploring longer term outcomes. The proposed research will be the first to analyse a population-based cohort of children exposed to opioids in pregnancy through to adolescence. This will allow us to explore a range of health, education and justice outcomes for children in Scotland, and to explore the pathways they take to these outcomes. The outcomes of children who were exposed to opioids through their mother's substance use will be compared with children in two other groups: 1) mothers who used opioids for chronic pain in pregnancy, and 2) children who are from similar socio-economic backgrounds but who were not exposed to opioids. We also don't know much about how drugs pass through to the unborn child during pregnancy, as the effects on the child do not seem to be directly linked to the mother's consumption. I will work with a forensic chemist to develop a test which changes colour depending on the type and amount of drugs (e.g. heroin, morphine, methadone) detected in blood samples. In Phase 1 this will be developed using animal bloods. In phase 2 we plan to test this on blood collected from the umbilical cord. During Phase 1 I will work with mothers who use opioids to gather information on their views and potential concerns around the use of cord blood, in order to ensure this research is conducted sensitively in Phase 2. There are other countries with excellent data linkage systems, but with smaller numbers of babies exposed to opioids in pregnancy. The second stage of this study will be to develop international collaborations, in order to access datasets from some Scandinavian and Commonwealth countries (New Zealand, Australia) and to test the pathways found on the Scottish data on these international datasets. In the rest of the UK, it is difficult to bring data together to the same degree as in Scotland. We will therefore work with other UK nations to improve these data linkages. This will mean that later in the study we can analyse data for the whole of the UK in a similar way to the Scottish data.Throughout the project we will work with women who use opioids, young adults whose mothers used opioids, and the charity organisations and policy-makers who support these families. This will ensure that we are asking the right questions and will be able to create useful and meaningful recommendations for future research and intervention.The results of this study will help us to understand the effects on children of opioid use during pregnancy and allow us to explore promising approaches for interventions to improve the support that is currently provided to women, adoptive families, and their children. Our findings will ensure that women across the world are given accurate information about the impact of opioid use in pregnancy to help provide their children with the best start in life.

在全球范围内，阿片类药物使用（例如海洛因）现在被视为“危机”。男性更有可能使用阿片类药物，但是近年来，使用阿片类药物的女性人数增加了。结果，阿片类药物使用的怀孕数量也在增加。已经有强有力的证据表明，在怀孕中使用阿片类药物会损害未出生的孩子，但对这些孩子的长期结局知之甚少：由于生活的复杂性，他们很难使用传统方法（例如反复的面对面访谈）在很长一段时间内很难进行跟进。苏格兰处于罕见的位置，即能够在一个人的一生中链接所有健康数据，以及将母亲和儿童数据联系起来，在所有国家 /地区都不易获得，并且具有高水平的阿片类药物使用。作为第一步，我表明我们可以从苏格兰经常收集的健康数据（例如产前记录，医院记录）中识别出在怀孕中使用非法或处方阿片类药物的妇女，并且可以将其与儿童的同等数据相匹配。这为我们提供了一种探索长期成果的方式。拟议的研究将是第一个分析在怀孕至青春期中暴露于阿片类药物的儿童基于人群的群体的研究。这将使我们能够探索苏格兰儿童的一系列健康，教育和正义成果，并探索他们对这些结果的途径。通过母亲的用途暴露于阿片类药物的儿童的结果将与另外两组的儿童进行比较：1）母亲在怀孕时使用阿片类药物治疗慢性疼痛，以及2）来自类似社会经济背景但未暴露于阿片类药物的孩子。我们也不了解毒品在怀孕期间如何传递给未出生的孩子，因为对孩子的影响似乎与母亲的消费没有直接相关。我将与法医化学家合作开发一项测试，该测试会根据在血液样本中检测到的药物的类型和量（例如海洛因，吗啡，美沙酮）。在第1阶段，这将使用动物血液开发。在第2阶段，我们计划对从脐带收集的血液进行测试。在第1阶段，我将与使用阿片类药物来收集有关其观点的信息以及有关使用脐带血的潜在问题的母亲，以确保在第2阶段敏感地进行这项研究。还有其他具有出色的数据连接系统的国家，但在怀孕期间暴露于阿片类药物的婴儿数量较小。这项研究的第二阶段是开发国际合作，以访问一些斯堪的纳维亚和英联邦国家（澳大利亚新西兰）的数据集，并测试这些国际数据集中苏格兰数据中发现的途径。在英国其他地区，很难将数据汇总到与苏格兰相同的程度。因此，我们将与其他英国国家合作，以改善这些数据链接。这将意味着，在研究的后面，我们可以以与苏格兰数据相似的方式分析整个英国的数据。通过该项目，我们将与使用阿片类药物的妇女，母亲使用阿片类药物的年轻人以及慈善组织和支持这些家庭的政策制定者一起工作。这将确保我们提出正确的问题，并能够为未来的研究和干预提出有用且有意义的建议。这项研究的结果将有助于我们了解怀孕期间对阿片类药物使用的儿童的影响，并允许我们探索有希望的方法，以改善为目前提供给妇女，收养家庭，收养家庭及其子女的支持的支持。我们的发现将确保为世界各地的妇女提供有关阿片类药物在怀孕中的影响的准确信息，以帮助他们的孩子提供最好的生活。