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Nezvalová-Henriksen K, Spigset O, Wood M, Nordeng H. The effect of prenatal nonsteroidal anti-inflammatory drug (NSAID) exposure on immediate pregnancy outcomes – A sibling controlled cohort study. Reprod Toxicol 2015. [DOI: 10.1016/j.reprotox.2015.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shah S, Banh ET, Koury K, Bhatia G, Nandi R, Gulur P. Pain Management in Pregnancy: Multimodal Approaches. PAIN RESEARCH AND TREATMENT 2015; 2015:987483. [PMID: 26448875 PMCID: PMC4584042 DOI: 10.1155/2015/987483] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022]
Abstract
Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately. Recent reports in the literature show that a significant percentage of pregnant women are treated with opioids during pregnancy. To address common pain conditions that present during pregnancy and the available pharmacological and nonpharmacological treatment options, for each of the pain conditions identified, a search using MEDLINE, PubMed, Embase, and Cochrane databases was performed. The quality of the evidence was evaluated in the context of study design. This paper is a narrative summary of the results obtained from individual reviews. There were significant disparities in the studies in terms of design, research and methodology, and outcomes analyzed. There is reasonable evidence available for pharmacological approaches; however, these are also associated with adverse events. Evidence for nonpharmacological approaches is limited and hence their efficacy is unclear, although they do appear to be primarily safe. A multimodal approach using a combination of nonpharmacological and pharmacological options to treat these pain conditions is likely to have the most benefit while limiting risk. Research trials with sound methodology and analysis of outcome data are needed.
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Affiliation(s)
- Shalini Shah
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, 333 The City Boulevard West, Suite 2150, Orange, CA 92868, USA
| | - Esther T. Banh
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, 333 The City Boulevard West, Suite 2150, Orange, CA 92868, USA
| | - Katharine Koury
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 444, Boston, MA 02114, USA
| | - Gaurav Bhatia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 444, Boston, MA 02114, USA
| | - Roneeta Nandi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray-Bigelow 444, Boston, MA 02114, USA
| | - Padma Gulur
- Department of Anesthesiology & Perioperative Care, University of California, Irvine, 333 The City Boulevard West, Suite 2150, Orange, CA 92868, USA
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Abstract
Pregnancy poses an important challenge for doctors looking after women with systemic lupus erythematosus. Knowledge about safety of medications, the effect of pregnancy on such disease, and vice versa, together with multidisciplinary team care, are basic cornerstones needed to provide the best obstetric and medical care to these women. Pre-conceptional counselling constitutes the ideal scenario where a patient's previous obstetric history, organ damage, disease activity, serological profile and additional medical history can be summarized. Important issues regarding medication adjustment, planned scans and visits, and main risks discussion should also be raised at this stage. Planned pregnancies lead to better outcomes for both mothers and babies. Close surveillance throughout pregnancy and the puerperium, and tailored management approach guarantee the highest rates of successful pregnancies in these women.
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Affiliation(s)
- O Ateka-Barrutia
- Lupus Research Unit, Women's Health Division, King's College London, UK
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