Prädiktoren zur Stabilisierung opioidabhängiger gravider Frauen mit Ausblick auf die elterliche Sorge

 

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Zusammenfassung

Ziele: Es sollen verschiedene Faktoren aufgezeigt werden, die zu einer Stabilisierung der opioidabhängigen Graviden führen und damit die Voraussetzung für die Fürsorge ihrer Kinder schaffen. Methode: Die Patientinnen wurden ambulant in einem standardisierten Setting entweder mit Methadon, retardiertem Morphin oder Buprenorphin behandelt. Als Zielparameter für den Verbleib des Kindes wurden der Zeitpunkt des Behandlungsbeginnes, die Retentionsrate, die Dauer und Art der Opioiderhaltungstherapie sowie die Frequenz der Teilnahme an der psychotherapeutischen Gruppe evaluiert. Patientinnen: Während des Untersuchungszeitraums von 42 Monaten wurden 113 schwangere opioidabhängige Frauen eingeschlossen. Ergebnisse: Von 94 im Untersuchungszeitraum geborenen Kindern waren zum Nacherhebungszeitpunkt noch 59,6 % der Kinder (n = 56) in mütterlicher Sorge. Die Dauer der Opioiderhaltungstherapie (p = 0,02) sowie die frühzeitige therapeutische Intervention (p = 0,03) und die Frequenz der Teilnahme an der Psychotherapie zeigten einen signifikanten Einfluss auf den Verbleib des Kindes. Diskussion: Substanzabhängigen graviden Frauen sollte ein frühzeitiger Behandlungsbeginn in einer multiprofessionellen Betreuungseinrichtung ermöglicht werden und dafür gilt es, Voraussetzungen zu schaffen.

Predictors for the Stabilization of Opioid Dependent Pregnant Women with an Outlook onto Parental Care

Aims: The aim of our study was to perform an analysis of different variables to determine which factors are responsible for stabilizing pregnant addicts, so that they could keep their child. Methods: All patients have been recruited through the drug outpatient clinic and had access to a standardized setting, including psychosocial and psychotherapeutical interventions. They were treated either with methadone, slow-release morphine or buprenorphine. Outcome measures whether the child can live with its own mother, were the time of enrolement, the length of treatment period, type and duration of maintenance therapy as well as attendance of psychotherapy. Patients: During the investigational period of 42 months 61 pregnant opioid (DSM IV: 304.0) and 52 polysubstance (DSM IV: 304.8) dependent pregnant women were enroled in the treatment program. Results: 94 children were born during the investigation period. At the end of this time frame 59.6 % (n = 56) of the children were still raised by their mothers. Duration of involvement in a maintenance program with replacement opioids (p = 0.02), as well as early intervention (p = 0.03) had a significant influence towards retaining custody of the child. In addition to successful pharmacological treatment, psychosocial and psychotherapeutical services influenced the outcome in respect of mothers keeping the child. Discussion: Special training programs of health care professionals could support early intervention and effective multiprofessional treatment that should be offered to each pregnant addicted woman.

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Univ.-Prof. Dr. Gabriele Fischer

Drogenambulanz

Klinische Abteilung für Allgemeine Psychiatrie, Universitätsklinik für Psychiatrie

AKH Wien

Währinger Gürtel 18-20

1090 Wien

Österreich

Email: gabriele.fischer@akh-wien.ac.at