RESUMO
OBJECTIVE: Buprenorphine (BUP) is commonly used for opioid maintenance therapy in pregnancy. Our goal was to determine whether liver dysfunction related to hepatitis C virus (HCV) infection impacts BUP dosing requirements in pregnancy. STUDY DESIGN: This was a retrospective cohort study of pregnant women with antenatal exposure to BUP to compare dosing between individuals positive versus negative for HCV infection. Spearman correlation tests were used to assess the relationship between BUP dose and HCV status. RESULTS: HCV infection was present in 103 (39%) of the patients. Patients with HCV infection required lower dose increases of BUP throughout pregnancy (p = 0.02). HCV viral load was positively correlated with the liver enzymes aspartate transaminase (r = 0.30, p = 0.003) and alanine transaminase (r = 0.25, p = 0.01). There was a negative correlation between HCV viral load and BUP dose during the second trimester (r = -0.27, p = 0.01) and third trimester (r = -0.20, p = 0.04). CONCLUSION: Women with HCV infection required less of an increase in BUP dose throughout pregnancy compared with women without HCV infection. Severity of HCV infection, as measured by viral load and liver enzymes, was also associated with BUP dosing.
Assuntos
Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Hepatite C Crônica , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Buprenorfina/metabolismo , Feminino , Hepatite C Crônica/sangue , Hepatite C Crônica/virologia , Humanos , Fígado/metabolismo , Tratamento de Substituição de Opiáceos , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos , Carga ViralRESUMO
As the rate of obesity increases in adolescent and adult women in the United States, practitioners of obstetrics see higher rates of gestational diabetes. Recent clinical studies suggest that women with gestational diabetes have impaired pancreatic beta-cell function and reduced beta-cell adaptation resulting in insufficient insulin secretion to maintain normal glycemia. Despite recent evidence that even mild hyperglycemia is associated with adverse pregnancy outcomes, controversies still exist in screening, management, and treatment of gestational diabetes. Initial studies regarding glyburide for treatment of gestational diabetes are promising. Overall, only about half of the women with gestational diabetes are screened in the postpartum period, an ideal time for education and intervention, to decrease incidence of glucose intolerance and progression to type 2 diabetes.