妊娠早期服用米非司酮和前列腺素对继续妊娠的安全讨论

Safety of Continuation of Pregnancy after First-trimester exposure to Mifepristone and Prostaglandin

关键词:  米非司酮  继续妊娠  meta分析

Key words:  mifepristone  continuation of pregnancy  meta-analysis

摘要:

目的 系统评价妊娠早期服用米非司酮对继续妊娠是否有不良影响。方法 计算机检索中国知网、万方数据库、维普数据库、Web of Science、Pubmed等数据库，检索时限从数据库建立时到2017年，纳入服用米非司酮后继续妊娠试验-对照研究以及病案报道。对纳入的文献进行质量评价，用RevMan 5.3软件进行统计分析，计算纳入试验-对照研究的合并比值比（OR）及其95% CI。结果 纳入4个试验-对照研究，Meta分析结果显示，口服紧急避孕药继续妊娠者产生不良反应的可能性是非口服紧急避孕者的6.09倍，6.72倍；米非司酮紧急避孕失败者如果选择继续妊娠，新生儿窒息发生率高于正常人群，合并计算的OR值7.65，95% CI为3.13~18.69；妊娠期服用米非司酮和同时服用米非司酮、前列腺素对继续妊娠造成新生儿畸形的发生率并无太大差异，合并计算的OR值0.45，95% CI为0.12~1.73。结论 表明妊娠早期服用米非司酮可能会对继续妊娠产生不良影响，如选择继续妊娠则要积极预防。但由于纳入的文献研究数量较少，上述结论尚需开展更多高质量研究进一步加以证明。

Abstract:

OBJECTIVE To assess the safety of continuation of pregnancy after first-trimester exposure to mifepristone. METHODS We searched China National Knowledge Infrastructure(CNKI), Wanfang Database, Chinese Scientific Journals Full-text Database(VIP), Web of Science, Pubmed. Randomized controlled trials(RCT) of the safety of continuation of pregnancy after first-trimester exposure to mifepristone were collected. Data analyses were performed with The RevMan 5.3 software. A total of 4 RCTs were included. RESULTS The results showed that, compared with control group, the pregnant women taking mifepristone for emergency contraception but failing to abort the fetus have higher rate of the adverse reaction(OR=6.09, 6.72). The rate of the neonatal asphyxia is significantly higher than the control group (OR=7.65, 95%CI 3.13-18.69). The rate of neonatal malformation of continuation of pregnancy after first-trimester exposure to mifepristone there was no significant differenc compared with the group which the mifepristone was associated with prostaglandin analogue (OR=0.45, 95%CI 0.12-1.73). CONCLUSION The pregnant women taking mifepristone during first-trimester have higher adverse reaction than the normal pregnant women. However, more randomized controlled trials with large sample size and quality are required to provide further evidences.