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Ernst A, Brix N, Lauridsen LLB, Olsen J, Parner ET, Liew Z, Olsen LH, Ramlau-Hansen CH. Acetaminophen (Paracetamol) Exposure During Pregnancy and Pubertal Development in Boys and Girls From a Nationwide Puberty Cohort. Am J Epidemiol 2019; 188:34-46. [PMID: 30202914 PMCID: PMC6321810 DOI: 10.1093/aje/kwy193] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/21/2018] [Indexed: 12/16/2022] Open
Abstract
This study explored the association between exposure to acetaminophen during pregnancy and pubertal development using data from 15,822 boys and girls in the longitudinal Puberty Cohort, nested within the Danish National Birth Cohort. Use of acetaminophen was reported 3 times during pregnancy and 6 months postpartum. In total, 54% of mothers indicated use at least once during pregnancy. Between 2012 and 2017, sons and daughters provided information on a wide range of pubertal milestones-including Tanner stages, axillary hair growth, and age at menarche or voice break and first ejaculation-every 6 months from 11 years of age until full sexual maturation. Data were analyzed using a regression model for interval-censored data, providing adjusted mean monthly differences in age at attaining the pubertal milestones according to intrauterine cumulative (weeks) and trimester-specific acetaminophen exposure. Our results suggested a tendency towards slightly earlier attainment of almost all studied markers of female pubertal development with increasing number of weeks of exposure (i.e., about 1.5-3 months earlier age at pubic hair, axillary hair, and acne development comparing unexposed with those prenatally exposed for more than 12 weeks). Male pubertal development had no strong association with acetaminophen exposure.
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Affiliation(s)
- Andreas Ernst
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Nis Brix
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Lea L B Lauridsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jørn Olsen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erik T Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Zeyan Liew
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Lars H Olsen
- Section for Paediatric Urology, Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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102
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Rac H, Gould AP, Eiland LS, Griffin B, McLaughlin M, Stover KR, Bland CM, Bookstaver PB. Common Bacterial and Viral Infections: Review of Management in the Pregnant Patient. Ann Pharmacother 2018; 53:639-651. [PMID: 30556401 DOI: 10.1177/1060028018817935] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review the treatment of common bacterial and viral infections occurring in the pregnant patient. DATA SOURCES A literature search of MEDLINE was performed (inception to October 2018). The Centers for Disease Control and Prevention website was utilized for additional information. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies and those conducted in humans were considered. DATA SYNTHESIS β-Lactams alone or in combination are the preferred treatment for many common infections in pregnancy, such as urinary tract infections, pelvic inflammatory disease (PID), gonococcal infections, syphilis, chancroid, upper- and lower-respiratory-tract infections, certain gastrointestinal infections, Group B Streptococcus, listeriosis, and intrauterine inflammation or infection. Macrolides, particularly azithromycin, are also utilized for the treatment of PID, chlamydia, gonococcal infections, chancroid, community-acquired pneumonia, and certain gastrointestinal infections. Other antibiotics or antivirals such as vancomycin, aminoglycosides, metronidazole, nitrofurantoin, fosfomycin, acyclovir, valacyclovir, and oseltamivir are included in the preferred therapy for some common bacterial and viral infections in pregnant patients as well. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence of treatments of common infections in pregnancy and provides a concise summary to guide clinicians on empirical treatment during pregnancy. CONCLUSIONS There are limited data on clinical outcomes in pregnant patients with common bacterial and viral infections. Empirical management decisions require balance of benefit and risk to both mother and infant. Although few clinical practice guidelines have quality evidence for strong recommendations in this population, clinicians should weigh antimicrobial dosing, pharmacokinetics, safety, and established effectiveness to optimize antimicrobial therapy in pregnancy.
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Affiliation(s)
- Hana Rac
- 1 University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Lea S Eiland
- 3 Auburn University Harrison School of Pharmacy, Meridian, MS, USA
| | - Brooke Griffin
- 4 Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Milena McLaughlin
- 4 Midwestern University Chicago College of Pharmacy, Downers Grove, IL, USA
| | - Kayla R Stover
- 5 University of Mississippi School of Pharmacy, Jackson, MS, USA
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103
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Sartori J, Petersen R, Coall DA, Quinlivan J. The impact of maternal nausea and vomiting in pregnancy on expectant fathers: findings from the Australian Fathers' Study. J Psychosom Obstet Gynaecol 2018; 39:252-258. [PMID: 28703034 DOI: 10.1080/0167482x.2017.1344831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Nausea and vomiting in pregnancy (NVP) are common. Whilst the impact on pregnant women has been well documented, there is less data on the impact on partners. This study evaluated awareness and impact of maternal NVP on expectant fathers. METHODS Observational study of 300 expectant fathers. Institutional ethics approval and consent were obtained. Fathers were recruited from antenatal clinics and community settings. Researchers administered demographic, attitudinal and the Hospital Anxiety and Depression scale questionnaires during the third trimester. Expectant fathers were asked if their partner experienced NVP. If aware, they were asked to comment upon the impact on their lives. RESULTS Participants were similar in demographics to those of the wider Australian community of expectant fathers. Most fathers were aware whether their partner experienced NVP (82%). Of these fathers, 20% reported no NVP, and 30%, 37% and 13% men reported maternal NVP was mild, moderate and severe, respectively. There was no correlation between paternal depression and maternal NVP, but a significant association was found between moderate and severe maternal NVP and paternal anxiety. In qualitative comments, five themes emerged: disruption on work, feelings of frustration and helplessness, concern over depression in their partner, concern for the developing baby and a sense of being manipulated in the third trimester of pregnancy. DISCUSSION Most expectant fathers are aware of NVP in their partner. Moderate and severe maternal NVP are associated with significantly higher symptoms of paternal anxiety.
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Affiliation(s)
- Julie Sartori
- a School of Medical and Health Sciences , Edith Cowan University , Joondalup , Australia
| | - Rodney Petersen
- b Women's and Babies Service, Women's and Children's Hospital , North Adelaide , Australia
| | - David A Coall
- a School of Medical and Health Sciences , Edith Cowan University , Joondalup , Australia.,c Division of Psychiatry, School of Medicine , The University of Western Australia , Crawley , Australia
| | - Julie Quinlivan
- d Institute for Health Research , University of Notre Dame Australia , Fremantle , Australia
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Tovo-Rodrigues L, Schneider BC, Martins-Silva T, Del-Ponte B, Loret de Mola C, Schuler-Faccini L, Vianna FSL, Munhoz TN, Entiauspe L, Silveira MF, Santos IS, Matijasevich A, Barros AJD, Rohde LA, Bertoldi AD. Is intrauterine exposure to acetaminophen associated with emotional and hyperactivity problems during childhood? Findings from the 2004 Pelotas birth cohort. BMC Psychiatry 2018; 18:368. [PMID: 30458756 PMCID: PMC6245767 DOI: 10.1186/s12888-018-1942-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Longitudinal studies have consistently reported that prenatal exposure to acetaminophen can to lead to an increased risk of attention deficit-hyperactivity disorder during childhood. This study aimed to investigate the association between intrauterine exposure to acetaminophen and the presence of emotional and behavioral problems at the ages of 6 and 11 years in a low-middle income country. METHODS We performed a prospective longitudinal population-based study using data from the 2004 Pelotas birth cohort. From the 4231 initial cohort participants, 3722 and 3566 children were assessed at 6 and 11 years of age, respectively. The outcomes were assessed using the parent version of Strengths and Difficulties Questionnaire (SDQ). The cut-off points established for the Brazilian population were used to categorize the outcomes. Crude and adjusted odds ratio were obtained through logistic regression. RESULTS Acetaminophen was used by 27.5% (95% confidence interval [CI]: 26.1-28.9) of the mothers at least once during pregnancy. The prevalence of emotional problems at 6 and 11 years was 13.6 and 19.9%, respectively. For hyperactivity problems, prevalence was 13.9 and 16.1%, respectively. Intrauterine exposure to acetaminophen increased the odds of having emotional (odds ratio [OR] = 1.47; 95% CI: 1.07-2.02) and hyperactivity/inattention (OR = 1.42; 95% CI: 1.06-1.92) problems in 6-year-old boys. At the age of 11, a small decrease in the effect was observed for both outcomes after adjustment: OR = 1.31 (95% CI: 0.99-1.73) for emotional problems and OR = 1.25 (95% CI: 0.95-1.65) for hyperactivity/inattention in boys. No association for any phenotypes at both ages was observed for girls. CONCLUSION The effect of intrauterine exposure to acetaminophen in emotional and hyperactivity symptoms was dependent on sex in a Brazilian cohort. While it seemed to be important for boys, mainly at 6 years of age, for girls, no association was observed.
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Affiliation(s)
- Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS, 96020-220, Brazil.
| | - Bruna Celestino Schneider
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Thais Martins-Silva
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Bianca Del-Ponte
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Christian Loret de Mola
- 0000 0001 2134 6519grid.411221.5School of Nursing and Public Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Fernanda Sales Luiz Vianna
- 0000 0001 2200 7498grid.8532.cPostgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande Do Sul, Porto Alegre, Brazil ,0000 0001 0125 3761grid.414449.8Genomic Medicine Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ,0000 0001 0125 3761grid.414449.8Laboratory of Research in Bioethics and Ethics in Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Tiago N. Munhoz
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil ,0000 0001 2134 6519grid.411221.5Department of Psychology, School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ludmila Entiauspe
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Mariângela Freitas Silveira
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Iná S. Santos
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Alicia Matijasevich
- 0000 0004 1937 0722grid.11899.38Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Aluísio J. D. Barros
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Luis Augusto Rohde
- 0000 0001 2200 7498grid.8532.cDepartment of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Andréa Dâmaso Bertoldi
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
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105
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Rossitto M, Marchive C, Pruvost A, Sellem E, Ghettas A, Badiou S, Sutra T, Poulat F, Philibert P, Boizet-Bonhoure B. Intergenerational effects on mouse sperm quality after in utero exposure to acetaminophen and ibuprofen. FASEB J 2018; 33:339-357. [PMID: 29979629 DOI: 10.1096/fj.201800488rrr] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nonsteroidal antiinflammatory drugs and analgesic drugs, such as N-acetyl- p-aminophenol (APAP; acetaminophen, paracetamol), are widely used by pregnant women. Accumulating evidence has indicated that these molecules can favor genital malformations in newborn boys and reproductive disorders in adults. However, the consequences on postnatal testis development and adult reproductive health after exposure during early embryogenesis are still unknown. Using the mouse model, we show that in utero exposure to therapeutic doses of the widely used APAP-ibuprofen combination during the sex determination period leads to early differentiation and decreased proliferation of male embryonic germ cells, and early 5-methylcytosine and extracellular matrix protein deposition in 13.5 d postcoitum exposed testes. Consequently, in postnatal testes, Sertoli-cell maturation is delayed, the Leydig-cell compartment is hyperplasic, and the spermatogonia A pool is decreased. This results in a reduced production of testosterone and in epididymal sperm parameter defects. We observed a reduced sperm count (19%) in utero-exposed (F0) adult males and also a reduced sperm motility (40%) in their offspring (F1) when both parents were exposed, which leads to subfertility among the 6 mo old F1 animals. Our study suggests that the use of these drugs during the critical period of sex determination affects the germ-line development and leads to adverse effects that could be passed to the offspring.-Rossitto, M., Marchive, C., Pruvost, A., Sellem, E., Ghettas, A., Badiou, S., Sutra, T., Poulat, F., Philibert, P., Boizet-Bonhoure, B. Intergenerational effects on mouse sperm quality after in utero exposure to acetaminophen and ibuprofen.
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Affiliation(s)
- Moïra Rossitto
- Institute of Human Genetics, Centre National de la Recherche Scientifique (CNRS), University of Montpellier, Montpellier, France
| | - Candice Marchive
- Institute of Human Genetics, Centre National de la Recherche Scientifique (CNRS), University of Montpellier, Montpellier, France
| | - Alain Pruvost
- Service de Pharmacologie et d'Immunoanalyse (SPI), Small Molecules Analysis by Mass Spectrometry (SMArt-MS), Commissariat à l'Energie Atomique (CEA), Institut National de la Recherche Agronomique (INRA), Université Paris-Saclay, Gif sur Yvette, France
| | - Eli Sellem
- Research and Development Department, Allice, Biology of Reproduction, Institut National de la Recherche Agronomique (INRA) Domaine de Vilvert, Jouy en Josas, France
| | - Aurélie Ghettas
- Service de Pharmacologie et d'Immunoanalyse (SPI), Small Molecules Analysis by Mass Spectrometry (SMArt-MS), Commissariat à l'Energie Atomique (CEA), Institut National de la Recherche Agronomique (INRA), Université Paris-Saclay, Gif sur Yvette, France
| | - Stéphanie Badiou
- Département de Biochimie et d'Hormonologie, Hopital Lapeyronie, Centre Hospitalier Universitaire (CHU) de Montpellier; PhyMedExp, INSERM Unité 1046, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 9214, Université de Montpellier, Montpellier, France
| | - Thibault Sutra
- Département de Biochimie et d'Hormonologie, Hopital Lapeyronie, Centre Hospitalier Universitaire (CHU) de Montpellier; PhyMedExp, INSERM Unité 1046, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 9214, Université de Montpellier, Montpellier, France
| | - Francis Poulat
- Institute of Human Genetics, Centre National de la Recherche Scientifique (CNRS), University of Montpellier, Montpellier, France
| | - Pascal Philibert
- Institute of Human Genetics, Centre National de la Recherche Scientifique (CNRS), University of Montpellier, Montpellier, France.,Département de Biochimie et d'Hormonologie, Hopital Lapeyronie, Centre Hospitalier Universitaire (CHU) de Montpellier; PhyMedExp, INSERM Unité 1046, Centre National de la Recherche Scientifique (CNRS) Unité Mixte de Recherche (UMR) 9214, Université de Montpellier, Montpellier, France
| | - Brigitte Boizet-Bonhoure
- Institute of Human Genetics, Centre National de la Recherche Scientifique (CNRS), University of Montpellier, Montpellier, France
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Maternal Biomarkers of Acetaminophen Use and Offspring Attention Deficit Hyperactivity Disorder. Brain Sci 2018; 8:brainsci8070127. [PMID: 29970852 PMCID: PMC6071105 DOI: 10.3390/brainsci8070127] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 12/14/2022] Open
Abstract
Previous studies have suggested a positive association between self-reported maternal acetaminophen use during pregnancy and risk of attention deficit hyperactivity disorder (ADHD) in offspring. We sought to examine the prospective association between maternal plasma biomarkers of acetaminophen intake and ADHD diagnosis in the offspring. This report analyzed 1180 children enrolled at birth and followed prospectively as part of the Boston Birth Cohort, including 188 with ADHD diagnosis based on electronic medical record review. Maternal biomarkers of acetaminophen intake were measured in plasma samples obtained within 1–3 days postpartum. Odds ratios for having ADHD diagnosis or other developmental disorders were estimated using multinomial logistic regression models, adjusting for pertinent covariables. Compared to neurotypical children, we observed significant positive dose-responsive associations with ADHD diagnosis for each maternal acetaminophen biomarker. These dose–responsive associations persisted after adjusting for indication of acetaminophen use and other pertinent covariates; and were specific to ADHD, rather than other neurodevelopmental disorders. In the stratified analyses, differential point estimates of the associations were observed across some strata of covariates. However, these differences were not statistically significant. Maternal acetaminophen biomarkers were specifically associated with increased risk of ADHD diagnosis in offspring. Additional clinical and mechanistic investigations are warranted.
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107
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Abreo A, Gebretsadik T, Stone CA, Hartert TV. The impact of modifiable risk factor reduction on childhood asthma development. Clin Transl Med 2018; 7:15. [PMID: 29892940 PMCID: PMC5995769 DOI: 10.1186/s40169-018-0195-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/04/2018] [Indexed: 01/14/2023] Open
Abstract
Childhood asthma is responsible for significant morbidity and health care expenditures in the United States. The incidence of asthma is greatest in early childhood, and the prevalence is projected to continue rising in the absence of prevention and intervention measures. The prevention of asthma will likely require a multifaceted intervention strategy; however, few randomized controlled trials have assessed such approaches. The purpose of this review was to use previous meta-analyses to identify the most impactful risk factors for asthma development and evaluate the effect of risk factor reduction on future childhood asthma prevalence. Common and modifiable risk factors with large effects included acute viral respiratory infections, antibiotic use, birth by cesarean section, nutritional disorders (overweight, obesity), second hand smoke exposure, allergen sensitization, breastfeeding, and sufficient prenatal vitamin D level. Evaluation and estimates of risk factor modification on populations at risk should guide scientists and policymakers toward high impact areas that are apt for additional study and intervention.
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Affiliation(s)
- Andrew Abreo
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tebeb Gebretsadik
- Department of Biostatistics, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cosby A Stone
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tina V Hartert
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA.
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108
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Bauer AZ, Kriebel D, Herbert MR, Bornehag CG, Swan SH. Prenatal paracetamol exposure and child neurodevelopment: A review. Horm Behav 2018; 101:125-147. [PMID: 29341895 DOI: 10.1016/j.yhbeh.2018.01.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/09/2017] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The non-prescription medication paracetamol (acetaminophen, APAP) is currently recommended as a safe pain and fever treatment during pregnancy. However, recent studies suggest a possible association between APAP use in pregnancy and offspring neurodevelopment. OBJECTIVES To conduct a review of publications reporting associations between prenatal APAP use and offspring neurodevelopmental outcomes. METHODS Relevant sources were identified through a key word search of multiple databases (Medline, CINAHL, OVID and TOXNET) in September 2016. All English language observational studies of pregnancy APAP and three classes of neurodevelopmental outcomes (autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and intelligence quotient (IQ)) were included. One reviewer (AZB) independently screened all titles and abstracts, extracted and analyzed the data. RESULTS 64 studies were retrieved and 55 were ineligible. Nine prospective cohort studies fulfilled all inclusion criteria. Data pooling was not appropriate due to heterogeneity in outcomes. All included studies suggested an association between prenatal APAP exposure and the neurodevelopmental outcomes; ADHD, ASD, or lower IQ. Longer duration of APAP use was associated with increased risk. Associations were strongest for hyperactivity and attention-related outcomes. Little modification of associations by indication for use was reported. CONCLUSIONS Together, these nine studies suggest an increased risk of adverse neurodevelopmental outcomes following prenatal APAP exposure. Further studies are urgently needed with; precise indication of use and exposure assessment of use both in utero and in early life. Given the current findings, pregnant women should be cautioned against indiscriminate use of APAP. These results have substantial public health implications.
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Affiliation(s)
- Ann Z Bauer
- Department of Public Health, University of Massachusetts, 1 University Avenue, Lowell, MA, 01854, USA.
| | - David Kriebel
- Department of Public Health, University of Massachusetts, 1 University Avenue, Lowell, MA, 01854, USA.
| | - Martha R Herbert
- Department of Neurology, MGH, Harvard Medical School, A.A. Martinos Centre for Biomedical Imaging, MGH/MIT/Harvard 149 Thirteenth Street, Charlestown, MA 02129, USA
| | - Carl-Gustaf Bornehag
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA; Department of Health Sciences, Karlstad University, Karlstad, Sweden.
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA.
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Hurtado-Gonzalez P, Anderson RA, Macdonald J, van den Driesche S, Kilcoyne K, Jørgensen A, McKinnell C, Macpherson S, Sharpe RM, Mitchell RT. Effects of Exposure to Acetaminophen and Ibuprofen on Fetal Germ Cell Development in Both Sexes in Rodent and Human Using Multiple Experimental Systems. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:047006. [PMID: 29665328 PMCID: PMC6071829 DOI: 10.1289/ehp2307] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/11/2018] [Accepted: 02/23/2018] [Indexed: 05/14/2023]
Abstract
BACKGROUND Analgesic exposure during pregnancy may affect aspects of fetal gonadal development that are targeted by endocrine disruptors. OBJECTIVES We investigated whether therapeutically relevant doses of acetaminophen and ibuprofen affect germ cell (GC) development in human fetal testes/ovaries using in vitro and xenograft approaches. METHODS First-trimester human fetal testes/ovaries were cultured and exposed to acetaminophen or ibuprofen (7 d). Second-trimester human fetal testes were xenografted into mice and exposed to acetaminophen (1 or 7 d), or ibuprofen (7 d). To determine mechanism of action, a human GC tumor–derived cell line (NTera2) exhibiting fetal GC characteristics was used in addition to in vitro and in vivo rat models. RESULTS AND DISCUSSION Gonocyte (TFAP2C+) number was reduced relative to controls in first-trimester human fetal testes exposed in vitro to acetaminophen (-28%) or ibuprofen (-22%) and also in ovaries exposed to acetaminophen (-43%) or ibuprofen (-49%). Acetaminophen exposure reduced gonocyte number by 17% and 30% in xenografted second-trimester human fetal testes after treatment of host mice for 1 or 7 d, respectively. NTera2 cell number was reduced following exposure to either analgesic or prostaglandin E2 (PGE2) receptor antagonists, whereas PGE2 agonists prevented acetaminophen-induced reduction in NTera2 cell number. Expression of GC pluripotency genes, and genes that regulate DNA/histone methylation, also differed from controls following analgesic and PGE2 receptor antagonist exposures. Gene expression changes were observed in rat fetal testis/ovary cultures and after in vivo acetaminophen exposure of pregnant rats. For example, expression of the epigenetic regulator TET1, was increased following exposure to acetaminophen in human NTera2 cells, rat fetal testis/ovary cultures, and in fetal testes and ovaries after in vivo exposure of pregnant rats, indicating translatability across experimental models and species. CONCLUSIONS Our results demonstrate evidence of PGE2-mediated effects of acetaminophen and ibuprofen on GC/NTera2 cells, which raises concerns about analgesic use during human pregnancy that warrant further investigation. https://doi.org/10.1289/EHP2307.
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Affiliation(s)
- Pablo Hurtado-Gonzalez
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard A Anderson
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Joni Macdonald
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sander van den Driesche
- Centre for Discovery Brain Sciences, Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Karen Kilcoyne
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Anne Jørgensen
- Department of Growth and Reproduction, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Chris McKinnell
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Sheila Macpherson
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard M Sharpe
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rod T Mitchell
- Medical Research Council (MRC) Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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110
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Aengenheister L, Keevend K, Muoth C, Schönenberger R, Diener L, Wick P, Buerki-Thurnherr T. An advanced human in vitro co-culture model for translocation studies across the placental barrier. Sci Rep 2018; 8:5388. [PMID: 29599470 PMCID: PMC5876397 DOI: 10.1038/s41598-018-23410-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/12/2018] [Indexed: 01/10/2023] Open
Abstract
Although various drugs, environmental pollutants and nanoparticles (NP) can cross the human placental barrier and may harm the developing fetus, knowledge on predictive placental transfer rates and the underlying transport pathways is mostly lacking. Current available in vitro placental transfer models are often inappropriate for translocation studies of macromolecules or NPs and do not consider barrier function of placental endothelial cells (EC). Therefore, we developed a human placental in vitro co-culture transfer model with tight layers of trophoblasts (BeWo b30) and placental microvascular ECs (HPEC-A2) on a low-absorbing, 3 µm porous membrane. Translocation studies with four model substances and two polystyrene (PS) NPs across the individual and co-culture layers revealed that for most of these compounds, the trophoblast and the EC layer both demonstrate similar, but not additive, retention capacity. Only the paracellular marker Na-F was substantially more retained by the BeWo layer. Furthermore, simple shaking, which is often applied to mimic placental perfusion, did not alter translocation kinetics compared to static exposure. In conclusion, we developed a novel placental co-culture model, which provides predictive values for translocation of a broad variety of molecules and NPs and enables valuable mechanistic investigations on cell type-specific placental barrier function.
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Affiliation(s)
- Leonie Aengenheister
- Particles-Biology Interactions, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland
| | - Kerda Keevend
- Particles-Biology Interactions, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland
| | - Carina Muoth
- Particles-Biology Interactions, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland
| | - René Schönenberger
- UTOX, EAWAG, Swiss Federal Institute of Aquatic Science and Technology, Ueberlandstrasse 133, 8600, Dübendorf, Switzerland
| | - Liliane Diener
- Particles-Biology Interactions, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland
| | - Peter Wick
- Particles-Biology Interactions, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland
| | - Tina Buerki-Thurnherr
- Particles-Biology Interactions, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland.
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111
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Green TL, Bodas MV, Jones HA, Masho SW, Hagiwara N. Disparities in Self-Reported Prenatal Counseling: Does Immigrant Status Matter? J Community Health 2018. [PMID: 29516385 DOI: 10.1007/s10900-018-0495-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Immigrant women face unique barriers to prenatal care access and patient-provider communication. Yet, few prior studies have examined U.S.-born/immigrant differences in the content of care. The purpose of this study was to investigate the roles of immigrant status, English proficiency and race/ethnicity on the receipt of self-reported prenatal counseling using nationally representative data. We used data from the Early Childhood Longitudinal Study-Birth Cohort (N ≈ 8100). We investigated differences in self-reported prenatal counseling by immigrant status, English proficiency, and race/ethnicity using logistic regression. Counseling topics included diet, smoking, drinking, medication use, breastfeeding, baby development and early labor. In additional analyses, we separately examined these relationships among Hispanic, Mexican and Non-Hispanic (NH) Asian women. Neither immigrant status nor self-reported English proficiency was associated with prenatal counseling. However, we found that being interviewed in a language other than English language by ECLS-B surveyors was positively associated with counseling on smoking (OR, 2.599; 95% CI, 1.229-5.495) and fetal development (OR, 2.408; 95% CI, 1.052-5.507) among Asian women. Race/ethnicity was positively associated with counseling, particularly among NH black and Hispanic women. There is little evidence of systematic overall differences in self-reported prenatal counseling between U.S.-born and immigrant mothers. Future research should investigate disparities in pregnancy-related knowledge among racial/ethnic subgroups.
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Affiliation(s)
- Tiffany L Green
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA.
| | - Mandar V Bodas
- Department of Health Behavior and Policy, VCU School of Medicine, Virginia Commonwealth University, Richmond, USA
| | - Heather A Jones
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Saba W Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
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112
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Konkel L. Reproductive Headache? Investigating Acetaminophen as a Potential Endocrine Disruptor. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:032001. [PMID: 29529598 PMCID: PMC6071750 DOI: 10.1289/ehp2478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 06/12/2023]
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113
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Ibuprofen is deleterious for the development of first trimester human fetal ovary ex vivo. Hum Reprod 2018; 33:482-493. [DOI: 10.1093/humrep/dex383] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/01/2018] [Indexed: 12/17/2022] Open
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114
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Abstract
Some studies suggest that prenatal infection increases risk of autism spectrum disorders (ASDs). This study was undertaken in a prospective cohort in Norway to examine whether we could find evidence to support an association of the prenatal occurrence of fever, a common manifestation of infection, with ASD risk. Prospective questionnaires provided maternal exposure data; case status was established from clinical assessments and registry linkages. In a large, prospectively ascertained cohort of pregnant mothers and their offspring, we examined infants born ⩾32 weeks for associations between fever exposure in each trimester and ASD risk using logistic regression. Maternal exposure to second-trimester fever was associated with increased ASD risk, adjusting for presence of fever in other trimesters and confounders (adjusted odds ratio (aOR), 1.40; 95% confidence interval, 1.09-1.79), with a similar, but nonsignificant, point estimate in the first trimester. Risk increased markedly with exposure to three or more fever episodes after 12 weeks' gestation (aOR, 3.12; 1.28-7.63). ASD risk appears to increase with maternal fever, particularly in the second trimester. Risk magnified dose dependently with exposure to multiple fevers after 12 weeks' gestation. Our findings support a role for gestational maternal infection and innate immune responses to infection in the pathogenesis of at least some cases of ASD.
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115
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Blundell C, Yi YS, Ma L, Tess ER, Farrell MJ, Georgescu A, Aleksunes LM, Huh D. Placental Drug Transport-on-a-Chip: A Microengineered In Vitro Model of Transporter-Mediated Drug Efflux in the Human Placental Barrier. Adv Healthc Mater 2018; 7:10.1002/adhm.201700786. [PMID: 29121458 PMCID: PMC5793852 DOI: 10.1002/adhm.201700786] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/22/2017] [Indexed: 12/16/2022]
Abstract
The current lack of knowledge about the effect of maternally administered drugs on the developing fetus is a major public health concern worldwide. The first critical step toward predicting the safety of medications in pregnancy is to screen drug compounds for their ability to cross the placenta. However, this type of preclinical study has been hampered by the limited capacity of existing in vitro and ex vivo models to mimic physiological drug transport across the maternal-fetal interface in the human placenta. Here the proof-of-principle for utilizing a microengineered model of the human placental barrier to simulate and investigate drug transfer from the maternal to the fetal circulation is demonstrated. Using the gestational diabetes drug glyburide as a model compound, it is shown that the microphysiological system is capable of reconstituting efflux transporter-mediated active transport function of the human placental barrier to limit fetal exposure to maternally administered drugs. The data provide evidence that the placenta-on-a-chip may serve as a new screening platform to enable more accurate prediction of drug transport in the human placenta.
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Affiliation(s)
- Cassidy Blundell
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA
| | - Yoon-Suk Yi
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA
| | - Lin Ma
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA
| | - Emily R. Tess
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA
| | - Megan J. Farrell
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA
| | - Andrei Georgescu
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA
| | - Lauren M. Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ
| | - Dongeun Huh
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA
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116
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Shenai N, Shulman J, Gopalan P, Cheng E, Cerimele JM. Fetal Outcomes in Intentional Over-the-Counter Medication Overdoses in Pregnancy. PSYCHOSOMATICS 2017; 59:400-404. [PMID: 29277425 DOI: 10.1016/j.psym.2017.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Neeta Shenai
- University of Pittsburgh Medical Center, Psychiatry, Pittsburgh, PA.
| | | | - Priya Gopalan
- University of Pittsburgh Medical Center, Psychiatry, Pittsburgh, PA
| | - Edith Cheng
- University of Washington, Obstetrics & Gynecology, Seattle, WA
| | - Joseph M Cerimele
- University of Washington School of Medicine, Psychiatry and Behavioral Sciences, Seattle, WA
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117
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Etwel F, Faught LH, Rieder MJ, Koren G. The Risk of Adverse Pregnancy Outcome After First Trimester Exposure to H1 Antihistamines: A Systematic Review and Meta-Analysis. Drug Saf 2017; 40:121-132. [PMID: 27878468 DOI: 10.1007/s40264-016-0479-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION H1 antihistamines are used for the treatment of nausea and vomiting during pregnancy as well as the symptomatic relief of asthma, urticaria, allergy, and the common cold. Although they are overall felt to be safe during pregnancy, recently several studies have challenged this assumption, as millions of women are exposed to them in the first trimester. METHODS Following the guidelines of PRISMA, a systematic review was performed to retrieve all published articles involving H1-antihistamine exposure during pregnancy. Electronic databases including PubMed and EMBASE were searched for possibly relevant articles published in any language up to December 2015. RESULTS After removing duplicate publications, and excluding animal studies and studies on drug effectiveness, 342 articles were reviewed in detail and 37 studies fulfilled the inclusion criteria for the meta-analysis. In cohort studies, the risk of major malformation in the offspring of women exposed to H1 antihistamines was not higher than that of the control population (OR 1.07; 95% CI 0.98-1.16). The Q-statistic for heterogeneity of effects was not significant (p > 0.05, I 2 < 25%) and there was no evidence of publication bias. Similar results were achieved with case-control studies (OR 1.05; 95% CI 0.90-1.23). Similarly, H1 antihistamines were not associated with more spontaneous abortions (OR 1.00; 95% CI 0.83-1.20), prematurity (OR 0.96; 95% CI 0.76-1.20), stillbirth (OR 1.23; 95% CI 0.48-3.18) or low birth weight (OR 1.20; 95% CI 0.63-2.29). CONCLUSIONS Based on our meta-analyses, which included a large number of studies, H1 antihistamines are not associated with an increased risk of major malformation or other adverse fetal outcomes. This study provides important information to both pregnant women and their healthcare providers regarding the safety and risk of H1 antihistamine use during this sensitive time.
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Affiliation(s)
- Fatma Etwel
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Lauren H Faught
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Michael J Rieder
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Gideon Koren
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada.
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118
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Kilcoyne KR, Mitchell RT. Assessing the impact of in-utero exposures: potential effects of paracetamol on male reproductive development. Arch Dis Child 2017; 102:1169-1175. [PMID: 28588045 DOI: 10.1136/archdischild-2016-311374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/03/2017] [Accepted: 05/03/2017] [Indexed: 12/21/2022]
Abstract
Human male reproductive disorders (cryptorchidism, hypospadias, testicular cancer and low sperm counts) are common and some may be increasing in incidence worldwide. These associated disorders can arise from subnormal testosterone production during fetal life. This has resulted in a focus on in-utero environmental influences that may result in reproductive effects on the offspring in later life. Over recent years, there has been a dramatic increase in the scientific literature describing associations between in-utero environmental exposures (eg, industrial chemicals and pharmaceuticals) and subsequent reproductive outcomes in male offspring. This includes studies investigating a potential role for in-utero analgesic exposure(s) on the fetal testis; however, providing definitive evidence of such effects presents numerous challenges. In this review, we describe an approach to assessing the potential clinical relevance of in-utero (and postnatal) environmental exposures on subsequent male reproductive function using exposure to the analgesic paracetamol as an example.
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Affiliation(s)
- Karen R Kilcoyne
- MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK.,Department of Diabetes and Endocrinology, Royal Hospital for Sick Children, Edinburgh, UK
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119
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Ystrom E, Gustavson K, Brandlistuen RE, Knudsen GP, Magnus P, Susser E, Davey Smith G, Stoltenberg C, Surén P, Håberg SE, Hornig M, Lipkin WI, Nordeng H, Reichborn-Kjennerud T. Prenatal Exposure to Acetaminophen and Risk of ADHD. Pediatrics 2017; 140:peds.2016-3840. [PMID: 29084830 PMCID: PMC5654387 DOI: 10.1542/peds.2016-3840] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To estimate the association between maternal use of acetaminophen during pregnancy and of paternal use before pregnancy with attention-deficit/hyperactivity disorder (ADHD) in offspring while adjusting for familial risk for ADHD and indications of acetaminophen use. METHODS Diagnoses were obtained from the Norwegian Patient Registry for 112 973 offspring from the Norwegian Mother and Child Cohort Study, including 2246 with ADHD. We estimated hazard ratios (HRs) for an ADHD diagnosis by using Cox proportional hazard models. RESULTS After adjusting for maternal use of acetaminophen before pregnancy, familial risk for ADHD, and indications of acetaminophen use, we observed a modest association between any prenatal maternal use of acetaminophen in 1 (HR = 1.07; 95% confidence interval [CI] 0.96-1.19), 2 (HR = 1.22; 95% CI 1.07-1.38), and 3 trimesters (HR = 1.27; 95% CI 0.99-1.63). The HR for more than 29 days of maternal acetaminophen use was 2.20 (95% CI 1.50-3.24). Use for <8 days was negatively associated with ADHD (HR = 0.90; 95% CI 0.81-1.00). Acetaminophen use for fever and infections for 22 to 28 days was associated with ADHD (HR = 6.15; 95% CI 1.71-22.05). Paternal and maternal use of acetaminophen were similarly associated with ADHD. CONCLUSIONS Short-term maternal use of acetaminophen during pregnancy was negatively associated with ADHD in offspring. Long-term maternal use of acetaminophen during pregnancy was substantially associated with ADHD even after adjusting for indications of use, familial risk of ADHD, and other potential confounders.
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Affiliation(s)
- Eivind Ystrom
- Norwegian Institute of Public Health, Oslo, Norway; .,Section of Health, Developmental, and Personality Psychology, Department of Psychology.,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, and
| | - Kristin Gustavson
- Norwegian Institute of Public Health, Oslo, Norway;,Section of Health, Developmental, and Personality Psychology, Department of Psychology
| | | | | | - Per Magnus
- Norwegian Institute of Public Health, Oslo, Norway;,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, New York;,New York State Psychiatric Institute, New York, New York
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom; and
| | - Camilla Stoltenberg
- Norwegian Institute of Public Health, Oslo, Norway;,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Pål Surén
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Mady Hornig
- Mailman School of Public Health, Columbia University, New York, New York
| | - W. Ian Lipkin
- Mailman School of Public Health, Columbia University, New York, New York
| | - Hedvig Nordeng
- Norwegian Institute of Public Health, Oslo, Norway;,PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, and
| | - Ted Reichborn-Kjennerud
- Norwegian Institute of Public Health, Oslo, Norway;,Faculty of Medicine, University of Oslo, Oslo, Norway
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120
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Interrante JD, Ailes EC, Lind JN, Anderka M, Feldkamp ML, Werler MM, Taylor LG, Trinidad J, Gilboa SM, Broussard CS. Risk comparison for prenatal use of analgesics and selected birth defects, National Birth Defects Prevention Study 1997-2011. Ann Epidemiol 2017; 27:645-653.e2. [PMID: 28993061 DOI: 10.1016/j.annepidem.2017.09.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or opioids to the use of acetaminophen without NSAIDs or opioids with respect to associations with birth defects. METHODS We used data from the National Birth Defects Prevention Study (1997-2011). Exposure was self-reported maternal analgesic use from the month before through the third month of pregnancy (periconceptional). Adjusted odds ratios (aORs) were calculated to examine associations with 16 birth defects. RESULTS Compared to acetaminophen, mothers reporting NSAIDs were significantly more likely to have offspring with gastroschisis, hypospadias, cleft palate, cleft lip with cleft palate, cleft lip without cleft palate, anencephaly, spina bifida, hypoplastic left heart syndrome, pulmonary valve stenosis, and tetralogy of Fallot (aOR range, 1.2-1.6). Opioids were associated with tetralogy of Fallot, perimembranous ventricular septal defect, and ventricular septal defect with atrial septal defect (aOR range, 1.8-2.3), whereas use of both opioids and NSAIDs was associated with gastroschisis, cleft palate, spina bifida, hypoplastic left heart syndrome, and pulmonary valve stenosis (aOR range, 2.0-2.9). CONCLUSIONS Compared to periconceptional use of acetaminophen, selected birth defects occurred more frequently among infants of women using NSAIDs and/or opioids. However, we could not definitely determine whether these risks relate to the drugs or to indications for treatment.
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Affiliation(s)
- Julia D Interrante
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN.
| | - Elizabeth C Ailes
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jennifer N Lind
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; United States Public Health Service, Atlanta, GA
| | - Marlene Anderka
- Birth Defects Monitoring Program, Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Martha M Werler
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Lockwood G Taylor
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - James Trinidad
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Suzanne M Gilboa
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cheryl S Broussard
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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121
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Xenotransplantation as a model for human testicular development. Differentiation 2017; 97:44-53. [DOI: 10.1016/j.diff.2017.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/08/2017] [Accepted: 09/05/2017] [Indexed: 11/20/2022]
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122
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Harris GME, Wood M, Eberhard-Gran M, Lundqvist C, Nordeng H. Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine. BMC Pregnancy Childbirth 2017; 17:224. [PMID: 28705177 PMCID: PMC5512742 DOI: 10.1186/s12884-017-1399-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 07/02/2017] [Indexed: 12/03/2022] Open
Abstract
Background Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine. This longitudinal drug utilization study aimed to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women. Methods Pregnant women giving birth at Akershus University Hospital between 2008 and 2010 were recruited at ultrasound examination in gestational week 17. Data were collected by questionnaires in gestational weeks 17 and 32, and at 8 weeks postpartum, and linked to birth records. Women were grouped into four categories according to migraine history: no migraine history, previous migraine history, recent migraine history (within 1 year prior to pregnancy) and migraine in pregnancy. Patterns of use of analgesics were analyzed descriptively. Multivariable logistic regression was used to identify factors predicting analgesic use. Results Out of 1981 women, 5.0% reported having migraine in pregnancy, 13.2% had a recent history of migraine, 11.5% had a previous history of migraine, and 68.8% reported no history of migraine. Analgesic use declined during pregnancy. Many women switched from triptans and non-steroidal anti-inflammatory drugs to paracetamol, which constituted most of the analgesic use. Factors associated with analgesic use included recent migraine history (OR 1.6, 95% CI 1.2–2.2), more severe headache intensity (OR 1.3, 95% CI 1.3–1.4), smoking (OR 1.9, 95% CI 1.1–3.3) and multiparity (OR 1.4, 95% CI 1.1–1.7). Conclusions Women with migraine stop or switch medications during pregnancy. Analgesic use in pregnancy is affected by migraine characteristics and intensity, and also by socio-demographic factors. Clinicians should bear this in mind when giving advice on adequate management of migraine in pregnancy and safe analgesic use. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1399-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gerd-Marie Eskerud Harris
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.
| | - Mollie Wood
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway
| | - Malin Eberhard-Gran
- Department of Child Health, National Institute of Public Health, Oslo, Norway.,Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research, Research Department, Akershus University Hospital and University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Hedvig Nordeng
- Pharmacoepidemiology & Drug Safety Research Group, School of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, P.O. Box. 1068, Blindern, 0316, Oslo, Norway.,Department of Child Health, National Institute of Public Health, Oslo, Norway
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123
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Al-Enazy S, Ali S, Albekairi N, El-Tawil M, Rytting E. Placental control of drug delivery. Adv Drug Deliv Rev 2017; 116:63-72. [PMID: 27527665 DOI: 10.1016/j.addr.2016.08.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/25/2016] [Accepted: 08/04/2016] [Indexed: 01/04/2023]
Abstract
The placenta serves as the interface between the maternal and fetal circulations and regulates the transfer of oxygen, nutrients, and waste products. When exogenous substances are present in the maternal bloodstream-whether from environmental contact, occupational exposure, medication, or drug abuse-the extent to which this exposure affects the fetus is determined by transport and biotransformation processes in the placental barrier. Advances in drug delivery strategies are expected to improve the treatment of maternal and fetal diseases encountered during pregnancy.
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124
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Riley LE, Cahill AG, Beigi R, Savich R, Saade G. Improving Safe and Effective Use of Drugs in Pregnancy and Lactation: Workshop Summary. Am J Perinatol 2017; 34:826-832. [PMID: 28142152 PMCID: PMC6193221 DOI: 10.1055/s-0037-1598070] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/27/2016] [Indexed: 12/16/2022]
Abstract
In February 2015, given high rates of use of medications by pregnant women and the relative lack of data on safety and efficacy of many drugs utilized in pregnancy, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the Society for Maternal-Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Pediatrics (AAP) convened a group of experts to review the "current" state of the clinical care and science regarding medication use during the perinatal period. The expert panel chose select medications to demonstrate what existing safety and efficacy data may be available for clinicians and patients when making decisions about use in pregnancy or lactation. Furthermore, these example medications also provided opportunities to highlight where data are lacking, thus forming a list of research gaps. Last, after reviewing the existing vaccine safety surveillance system as well as the legislative history surrounding the use of drugs for pediatric diseases, the expert panel made specific recommendations concerning policy efforts to stimulate more research and regulatory attention on drugs for pregnant and lactating women.
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Affiliation(s)
- Laura E. Riley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alison G. Cahill
- Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri
| | - Richard Beigi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, Pennsylvania
| | - Renate Savich
- Division of Newborn Medicine and Neonatal Intensive Care Unit, University of Mississippi Medical Center, Jackson, Mississippi
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas
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Abstract
PURPOSE OF REVIEW Male reproductive disorders are common and increasing in incidence in many countries. Environmental factors (including pharmaceuticals) have been implicated in the development of these disorders. This review aims to summarize the emerging epidemiological and experimental evidence for a potential role of in-utero exposure to analgesics in the development of male reproductive disorders. RECENT FINDINGS A number of epidemiological studies have demonstrated an association between in utero exposure to analgesics and the development of cryptorchidism, although these findings are not consistent across all studies. Where present, these associations primarily relate to exposure during the second trimester of pregnancy. In vivo and in vitro experimental studies have demonstrated variable effects of exposure to analgesics on Leydig cell function in the fetal testis of rodents, particularly in terms of testosterone production. These effects frequently involve exposures that are in excess of those to which humans are exposed. Investigation of the effects of analgesics on human fetal testis have also demonstrated effects on Leydig cell function. Variation in species, model system, dosage and timing of exposure is likely to contribute to differences in the findings between studies. SUMMARY There is increasing evidence for analgesic effects on the developing testis that have the potential to impair male reproductive function. However, the importance of these findings in relation to human-relevant exposures and the risk of male reproductive disorders remain unclear.
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Affiliation(s)
- Pablo Hurtado-Gonzalez
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK
| | - Rod T. Mitchell
- MRC Centre for Reproductive Health, The University of Edinburgh, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, Scotland, UK
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126
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Riepl R, Friebe-Hoffmann U. [Drug therapy of otorhinolaryngological diseases in pregnancy : An update]. HNO 2017; 64:843-854. [PMID: 27680545 DOI: 10.1007/s00106-016-0236-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The majority of women take at least one form of medication during pregnancy. Due to often discrepant information about the risk assessment of pharmaceuticals during pregnancy, physicians are often beset by uncertainty with respect to prescription and the fear of medicolegal consequences is high. As prospective clinical trials on drug safety during pregnancy are prohibited due to ethical reasons and animal studies are of limited applicability to humans, drug recommendations often only rely on observational data. An objective examination of the topic not only contributes to effective treatment of illnesses in pregnancy but also prevents impairment of fetal outcome by omission of necessary maternal treatment. The aim of this article is to give a structured presentation of medications that can be used during pregnancy for treating medical conditions of the ear, nose and throat, in the sense of practical guidelines.
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Affiliation(s)
- R Riepl
- Klinik für Hals-Nasen-Ohrenheilkunde und Kopf-Hals-Chirurgie, Universität Ulm, Frauensteige 12, 89073, Ulm, Deutschland.
| | - U Friebe-Hoffmann
- Klinik für Gynäkologie und Geburtshilfe, Universität Ulm, Ulm, Deutschland
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127
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Philippot G, Gordh T, Fredriksson A, Viberg H. Adult neurobehavioral alterations in male and female mice following developmental exposure to paracetamol (acetaminophen): characterization of a critical period. J Appl Toxicol 2017; 37:1174-1181. [DOI: 10.1002/jat.3473] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/27/2017] [Accepted: 03/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Gaëtan Philippot
- Department of Environmental Toxicology; Uppsala University; Sweden
| | - Torsten Gordh
- Department of Surgical Sciences; Uppsala University; Sweden
| | | | - Henrik Viberg
- Department of Environmental Toxicology; Uppsala University; Sweden
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128
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Devkota R, Khan GM, Alam K, Sapkota B, Devkota D. Impacts of counseling on knowledge, attitude and practice of medication use during pregnancy. BMC Pregnancy Childbirth 2017; 17:131. [PMID: 28449651 PMCID: PMC5408448 DOI: 10.1186/s12884-017-1316-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background Counseling has a significant role in improving knowledge, attitude and practice outcomes of pregnant women towards medication use. Proper counseling thus could be beneficial to prevent any medication related misadventure during pregnancy. The present study was aimed to assess the knowledge, attitude and practice (KAP) of pregnant women towards their medications, to provide counseling regarding their understanding of medication use during pregnancy and evaluate the impacts of such counseling. Methods Pre- post interventional (counseling) study was conducted at Manipal Teaching Hospital, Nepal among pregnant women who presented with complication and were prescribed at least one medication. A total of 275 pregnant women were included in the study. A structured questionnaire was used to assess the knowledge, attitude and practice of pregnant women before and after counseling. The impacts of counseling were then evaluated using suitable statistical methods. Results Of the total participants 229 completed the post counseling survey. Majority of the participants were in the age group 20-24 (43.2%), primigravida (59.4%) and in third trimester (58.6%). Housewives comprised 61.1% of participants and majority had received a University degree (33.2%). The mean and median scores assessed before counseling showed that there was no significant difference in the KAP scores with respect to age, trimester and gravidity whereas KAP scores with respect to occupation and level of education were statistically significant. There was an increase in mean and median KAP scores after counseling and the impacts of counseling was found to be statistically significant (p = <0.001). Conclusion Counseling had a positive impact on knowledge, attitude and practice of pregnant women towards medication and thus it could be considered a suitable method to encourage safe medication during pregnancy. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1316-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - G M Khan
- Pokhara University, Kaski, Nepal
| | - Kadir Alam
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Deepa Devkota
- People's Dental College and Hospital, Kathmandu, Nepal
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129
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Palmsten K, Flores KF, Chambers CD, Weiss LA, Sundaram R, Buck Louis GM. Most Frequently Reported Prescription Medications and Supplements in Couples Planning Pregnancy: The LIFE Study. Reprod Sci 2017; 25:94-101. [PMID: 28401798 DOI: 10.1177/1933719117702249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify frequently reported prescription medications and supplements among couples planning pregnancy because there is a lack of descriptive information on these agents in women and men who are trying to conceive. METHODS Five hundred one couples enrolled in the Longitudinal Study of Infertility and the Environment, which took place between 2005 and 2009. Participants reported prescription medications as well as prescription and over-the-counter supplements used through interviews at study enrollment and through daily dairies during the 12-month follow-up. We identified prescription medications and supplements prospectively reported by ≥1% of women and men at baseline and from daily journal information grouped into 3-month preconception follow-up intervals while couples tried for pregnancy. RESULTS The 5 most reported prescription medications among women were levothyroxine (5.8%), cetirizine (2.6%), fluticasone (2.4%), escitalopram (1.8%), and fluoxetine (1.8%) and for men were lisinopril (2.0%), mometasone (2.0%), fexofenadine (1.8%), atorvastatin (1.6%), and montelukast (1.6%). The most reported supplements were multivitamins (63.3%, 43.5%) and fish oil (13.2%, 9.4%) for women and men, respectively, and prenatal vitamins (22.0%) for women. For women during the first 3 months of follow-up, prenatal vitamins (6.0%) and antibiotics (1.2%-2.6%) were among the most frequently started medications. During the next 3 months, clomiphene (4.5%) was the most frequently initiated medication. CONCLUSIONS Couples trying for pregnancy reported a variety of prescription medications and supplements, and they differed by gender. Preconception guidance should address medication and supplement use to avoid potential exposures associated with adverse reproductive and perinatal outcomes.
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Affiliation(s)
- Kristin Palmsten
- 1 Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Katrina F Flores
- 2 Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Christina D Chambers
- 1 Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.,2 Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Lauren A Weiss
- 3 Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Rajeshwari Sundaram
- 4 Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | - Germaine M Buck Louis
- 4 Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
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130
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Fetal and neonatal rats paracetamol dosage and the perinatal human setting: Lost in translation? Pharmacol Rep 2017; 69:371-372. [DOI: 10.1016/j.pharep.2016.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/27/2016] [Indexed: 11/18/2022]
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131
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Parker W, Hornik CD, Bilbo S, Holzknecht ZE, Gentry L, Rao R, Lin SS, Herbert MR, Nevison CD. The role of oxidative stress, inflammation and acetaminophen exposure from birth to early childhood in the induction of autism. J Int Med Res 2017; 45:407-438. [PMID: 28415925 PMCID: PMC5536672 DOI: 10.1177/0300060517693423] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The wide range of factors associated with the induction of autism is invariably linked with either inflammation or oxidative stress, and sometimes both. The use of acetaminophen in babies and young children may be much more strongly associated with autism than its use during pregnancy, perhaps because of well-known deficiencies in the metabolic breakdown of pharmaceuticals during early development. Thus, one explanation for the increased prevalence of autism is that increased exposure to acetaminophen, exacerbated by inflammation and oxidative stress, is neurotoxic in babies and small children. This view mandates extreme urgency in probing the long-term effects of acetaminophen use in babies and the possibility that many cases of infantile autism may actually be induced by acetaminophen exposure shortly after birth.
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Affiliation(s)
- William Parker
- 1 Departments of Surgery, Duke University Medical Center, Durham, NC USA
| | - Chi Dang Hornik
- 2 Departments of Pediatrics, Duke University Medical Center, Durham, NC USA
| | - Staci Bilbo
- 3 Departments of Pediatrics, Harvard Medical School, Charlestown, MA, USA
| | - Zoie E Holzknecht
- 1 Departments of Surgery, Duke University Medical Center, Durham, NC USA
| | - Lauren Gentry
- 1 Departments of Surgery, Duke University Medical Center, Durham, NC USA
| | - Rasika Rao
- 1 Departments of Surgery, Duke University Medical Center, Durham, NC USA
| | - Shu S Lin
- 1 Departments of Surgery, Duke University Medical Center, Durham, NC USA
| | - Martha R Herbert
- 4 Departments of Neurology, Harvard Medical School, Charlestown, MA, USA
| | - Cynthia D Nevison
- 5 Institute for Arctic and Alpine Research, University of Colorado, Boulder, Boulder, CO, USA
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Ibuprofen results in alterations of human fetal testis development. Sci Rep 2017; 7:44184. [PMID: 28281692 PMCID: PMC5345102 DOI: 10.1038/srep44184] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
Among pregnant women ibuprofen is one of the most frequently used pharmaceutical compounds with up to 28% reporting use. Regardless of this, it remains unknown whether ibuprofen could act as an endocrine disruptor as reported for fellow analgesics paracetamol and aspirin. To investigate this, we exposed human fetal testes (7–17 gestational weeks (GW)) to ibuprofen using ex vivo culture and xenograft systems. Ibuprofen suppressed testosterone and Leydig cell hormone INSL3 during culture of 8–9 GW fetal testes with concomitant reduction in expression of the steroidogenic enzymes CYP11A1, CYP17A1 and HSD17B3, and of INSL3. Testosterone was not suppressed in testes from fetuses younger than 8 GW, older than 10–12 GW, or in second trimester xenografted testes (14–17 GW). Ex vivo, ibuprofen also affected Sertoli cell by suppressing AMH production and mRNA expression of AMH, SOX9, DHH, and COL2A1. While PGE2 production was suppressed by ibuprofen, PGD2 production was not. Germ cell transcripts POU5F1, TFAP2C, LIN28A, ALPP and KIT were also reduced by ibuprofen. We conclude that, at concentrations relevant to human exposure and within a particular narrow ‘early window’ of sensitivity within first trimester, ibuprofen causes direct endocrine disturbances in the human fetal testis and alteration of the germ cell biology.
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Kodama M, Kurokawa J. A risk assessment of a common drug using xenograft model. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:88. [PMID: 28275633 DOI: 10.21037/atm.2017.01.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Masami Kodama
- Department of Bio-Informational Pharmacology, Medical Research Institute, Tokyo Medical Dental University, Tokyo, Japan
| | - Junko Kurokawa
- Department of Bio-Informational Pharmacology, Medical Research Institute, Tokyo Medical Dental University, Tokyo, Japan; ; Department of Bio-Informational Pharmacology, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
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Kress HG, Untersteiner G. Clinical update on benefit versus risks of oral paracetamol alone or with codeine: still a good option? Curr Med Res Opin 2017; 33:289-304. [PMID: 27842443 DOI: 10.1080/03007995.2016.1254606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND After decades of worldwide use of paracetamol/acetaminophen as a popular and apparently safe prescription and over-the-counter medicine, the future role of this poorly understood analgesic has been seriously questioned by recent concerns about prenatal, cardiovascular (CV) and hepatic safety, and also about its analgesic efficacy. At the same time the usefulness of codeine in combination products has come under debate. METHODS Based on a PubMed database literature search on the terms efficacy, safety, paracetamol, acetaminophen, codeine and their combinations up to and including June 2016, this clinical update reviews the current evidence of the benefit and risks of oral paracetamol alone and with codeine for mild-to-moderate pain in adults, and compares the respective efficacy and safety profiles with those of nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS Whereas there is a clear strong association of NSAID use and gastrointestinal (GI) and CV morbidity and mortality, evidence for paracetamol with and without codeine supports the recommended use even in most vulnerable individuals, such as the elderly, pregnant women, alcoholics, and compromised GI and CV patients. The controversies and widespread misconceptions about the complex hepatic metabolism and potential hepatotoxicity have been corrected by recent reviews, and paracetamol remains the first-line nonopioid analgesic in patients with liver diseases if notes of caution are applied. CONCLUSION Due to its safety and tolerability profile paracetamol remained a first-line treatment in many international guidelines. Alone and with codeine it is a safe and effective option in adults, whilst NSAIDs are obviously less safe as alternatives, given the risk of potentially fatal GI and CV adverse effects.
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Welham SJM, Sparrow AJ, Gardner DS, Elmes MJ. Acetylsalicylic acid interferes with embryonic kidney growth and development by a prostaglandin-independent mechanism. World J Nephrol 2017; 6:21-28. [PMID: 28101448 PMCID: PMC5215205 DOI: 10.5527/wjn.v6.i1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/14/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the effects of the non-selective, non-steroidal anti-inflammatory drug (NSAID) acetylsalicylic acid (ASA), on ex vivo embryonic kidney growth and development.
METHODS Pairs of fetal mouse kidneys at embryonic day 12.5 were cultured ex vivo in increasing concentrations of ASA (0.04-0.4 mg/mL) for up to 7 d. One organ from each pair was grown in control media and was used as the internal control for the experimental contralateral organ. In some experiments, organs were treated with ASA for 48 h and then transferred either to control media alone or control media containing 10 μmol/L prostaglandin E2 (PGE2) for a further 5 d. Fetal kidneys were additionally obtained from prostaglandin synthase 2 homozygous null or heterozygous (PTGS2-/- and PTGS2-/+) embryos and grown in culture. Kidney cross-sectional area was used to determine treatment effects on kidney growth. Whole-mount labelling to fluorescently detect laminin enabled crude determination of epithelial branching using confocal microscopy.
RESULTS Increasing ASA concentration (0.1, 0.2 and 0.4 mg/mL) significantly inhibited metanephric growth (P < 0.05). After 7 d of culture, exposure to 0.2 mg/mL and 0.4 mg/mL reduced organ size to 53% and 23% of control organ size respectively (P < 0.01). Addition of 10 μmol/L PGE2 to culture media after exposure to 0.2 mg/mL ASA for 48 h resulted in a return of growth area to control levels. Application of control media alone after cessation of ASA exposure showed no benefit on kidney growth. Despite the apparent recovery of growth area with 10 μmol/L PGE2, no obvious renal tubular structures were formed. The number of epithelial tips generated after 48 h exposure to ASA was reduced by 40% (0.2 mg/mL; P < 0.05) and 47% (0.4 mg/mL; P < 0.01). Finally, growth of PTGS2-/- and PTGS2+/- kidneys in organ culture showed no differences, indicating that PTGS2 derived PGE2 may at best have a minor role.
CONCLUSION ASA reduces early renal growth and development but the role of prostaglandins in this may be minor.
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Liew Z, Bach CC, Asarnow RF, Ritz B, Olsen J. Paracetamol use during pregnancy and attention and executive function in offspring at age 5 years. Int J Epidemiol 2016; 45:2009-2017. [DOI: 10.1093/ije/dyw296] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 12/12/2022] Open
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Nezvalová-Henriksen K, Wood M, Spigset O, Nordeng H. Association of Prenatal Ibuprofen Exposure with Birth Weight and Gestational Age: A Population-Based Sibling Study. PLoS One 2016; 11:e0166971. [PMID: 27936000 PMCID: PMC5147859 DOI: 10.1371/journal.pone.0166971] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 10/29/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Three studies so far have investigated the effect of prenatal non-steroidal anti-inflammatory drug (NSAID) exposure on birth weight and gestational age. The aim in this study was to evaluate the association of prenatal ibuprofen with birth weight and gestational age at birth, using a sibling design in an attempt to adjust for the possibility of familial confounding. DESIGN Using data from the Norwegian Mother and Child Cohort Study (MoBa) and the Medical Birth Registry of Norway (MBRN), we identified 28 597 siblings, of whom 1080 were prenatally exposed to ibuprofen and 26 824 were not exposed to any NSAID. Random and fixed effects models with propensity score adjustment were used to evaluate the effects of ibuprofen exposure on birth weight and gestational age. RESULTS Ibuprofen exposure during the first trimester was associated with a decrease in birth weight of 79 grams (95% confidence interval -133 to -25 grams). In contrast, second and/or third trimester exposure, and duration of exposure had no impact on the effect estimates. We found no association between ibuprofen exposure and gestational age at birth. CONCLUSIONS Our results suggest that prenatal exposure to ibuprofen during the first trimester is associated with a slight decrease in birth weight. The association does not seem to be attributable to shared genetics and family environment, and could be explained by either exposure to ibuprofen, or to non-shared confounding between pregnancies.
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Affiliation(s)
| | - Mollie Wood
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Olav Spigset
- Department of Clinical Pharmacology, St Olav’s University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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139
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Cerebellar level of neurotransmitters in rats exposed to paracetamol during development. Pharmacol Rep 2016; 68:1159-1164. [DOI: 10.1016/j.pharep.2016.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 01/24/2023]
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140
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Lind DV, Main KM, Kyhl HB, Kristensen DM, Toppari J, Andersen HR, Andersen MS, Skakkebæk NE, Jensen TK. Maternal use of mild analgesics during pregnancy associated with reduced anogenital distance in sons: a cohort study of 1027 mother–child pairs. Hum Reprod 2016; 32:223-231. [DOI: 10.1093/humrep/dew285] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/16/2016] [Accepted: 10/10/2016] [Indexed: 12/19/2022] Open
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McInerney KA, Hatch EE, Wesselink AK, Rothman KJ, Mikkelsen EM, Wise LA. Preconception use of pain-relievers and time-to-pregnancy: a prospective cohort study. Hum Reprod 2016; 32:103-111. [PMID: 27816920 DOI: 10.1093/humrep/dew272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 09/27/2016] [Accepted: 10/19/2016] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION To what extent is preconception use of pain-relieving medication associated with female fecundability? SUMMARY ANSWER Women who used naproxen or opioids had slightly lower fecundability than women who did not use any pain-relieving medications; use of acetaminophen, aspirin and ibuprofen was not appreciably associated with fecundability. WHAT IS KNOWN ALREADY Over-the-counter pain-relieving medications are commonly used by women of reproductive age in the USA. Studies investigating the effects of pain-relieving medication use on ovulation, implantation and fecundability have shown conflicting results. STUDY DESIGN, SIZE, DURATION We analyzed data from an internet-based prospective cohort study of 2573 female pregnancy planners aged 21-45 years from the USA and Canada. Participants were enrolled and followed from June 2013 through September 2015. Participants completed a baseline questionnaire and bimonthly follow-up questionnaires until a reported pregnancy or for 12 months, whichever occurred first. Over 80% of participants completed at least one follow-up questionnaire. PARTICIPANTS/MATERIALS, SETTING, METHODS Use of pain-relieving medication during the past month was assessed at baseline and on each follow-up questionnaire. Medications were categorized according to type (acetaminophen, aspirin, ibuprofen, naproxen and opioids) and total monthly dose. Self-reported pregnancy was assessed at each follow-up. Multivariable-adjusted fecundability ratios (FRs) and 95% CI were calculated using proportional probabilities regression. Models were adjusted for demographic, lifestyle and anthropometric factors; reproductive history; gynecologic morbidity; and indications for use of pain medications. Models were also run with and without adjustment for parity. After restricting to women with 6 or fewer months of attempt time at study entry, 1763 were included in the analyses. MAIN RESULTS AND THE ROLE OF CHANCE At baseline, 1279 (73%) women reported using ≥1 pain-relieving medications in the previous month. When compared with non-use of pain-relieving medications, FRs for use of naproxen and opioids at baseline were 0.78 (95% CI: 0.64-0.97) and 0.81 (95% CI: 0.60-1.10), respectively. A dose-response relation was observed between naproxen use and fecundability; FRs for use of <1500 and ≥1500 mg of naproxen were 0.85 (95% CI: 0.68-1.07) and 0.58 (95% CI: 0.36-0.94), respectively. Small numbers (n = 74) precluded the examination of opioid use by dose. Overall, there was little evidence of an association between fecundability and acetaminophen (FR 1.04, 95% CI: 0.92-1.18), aspirin (FR 1.00, 95% CI: 0.80-1.25), or ibuprofen (FR 1.00, 95% CI: 0.89-1.11). Similar results were observed when exposure information was updated over time. LIMITATIONS, REASONS FOR CAUTION Numbers of opioid users were small. Information collected on reason for use of pain medications was not specific to each type of pain medication. Therefore, we cannot rule out confounding by indication as an explanation of these results. WIDER IMPLICATIONS OF THE FINDINGS Use of naproxen and opioids was associated with a small reduction in fecundability, but there was little association between other pain-relieving medications and fecundability. STUDY FUNDING/COMPETING INTERESTS This study was supported through funds provided by National Institute of Child Health and Human Development, National Institute of Health (R21 HD072326, T32 HD052458). The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Kathryn A McInerney
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 3rd Floor, Boston, MA 02118, USA
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 3rd Floor, Boston, MA 02118, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 3rd Floor, Boston, MA 02118, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 3rd Floor, Boston, MA 02118, USA.,RTI Health Solutions, PO Box 12194, Research Triangle Park, NC 27709, USA
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Norrebrogade 44, DK-8000 Aarhus, Denmark
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, 3rd Floor, Boston, MA 02118, USA
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Abstract
BACKGROUND Women are commonly prescribed a variety of medications during pregnancy. As most organ systems are affected by the substantial anatomical and physiological changes that occur during pregnancy, it is expected that pharmacokinetics (PK) (absorption, distribution, metabolism, and excretion of drugs) would also be affected in ways that may necessitate changes in dosing schedules. The objective of this study was to systematically identify existing clinically relevant evidence on PK changes during pregnancy. METHODS AND FINDINGS Systematic searches were conducted in MEDLINE (Ovid), Embase (Ovid), Cochrane Central Register of Controlled Trials (Ovid), and Web of Science (Thomson Reuters), from database inception to August 31, 2015. An update of the search from September 1, 2015, to May 20, 2016, was performed, and relevant data were added to the present review. No language or date restrictions were applied. All publications of clinical PK studies involving a group of pregnant women with a comparison to nonpregnant participants or nonpregnant population data were eligible to be included in this review. A total of 198 studies involving 121 different medications fulfilled the inclusion criteria. In these studies, commonly investigated drug classes included antiretrovirals (54 studies), antiepileptic drugs (27 studies), antibiotics (23 studies), antimalarial drugs (22 studies), and cardiovascular drugs (17 studies). Overall, pregnancy-associated changes in PK parameters were often observed as consistent findings among many studies, particularly enhanced drug elimination and decreased exposure to total drugs (bound and unbound to plasma proteins) at a given dose. However, associated alterations in clinical responses and outcomes, or lack thereof, remain largely unknown. CONCLUSION This systematic review of pregnancy-associated PK changes identifies a significant gap between the accumulating knowledge of PK changes in pregnant women and our understanding of their clinical impact for both mother and fetus. It is essential for clinicians to be aware of these unique pregnancy-related changes in PK, and to critically examine their clinical implications.
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144
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Stergiakouli E, Thapar A, Davey Smith G. Association of Acetaminophen Use During Pregnancy With Behavioral Problems in Childhood: Evidence Against Confounding. JAMA Pediatr 2016; 170:964-970. [PMID: 27533796 PMCID: PMC5300094 DOI: 10.1001/jamapediatrics.2016.1775] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Acetaminophen (paracetamol) is used by a large proportion of pregnant women. Research suggests that acetaminophen use in pregnancy is associated with abnormal fetal neurodevelopment. However, it is possible that this association might be confounded by unmeasured behavioral factors linked to acetaminophen use. OBJECTIVE To examine associations between offspring behavioral problems and (1) maternal prenatal acetaminophen use, (2) maternal postnatal acetaminophen use, and (3) partner's acetaminophen use. DESIGN, SETTING, AND PARTICIPANTS From February 2015 to March 2016, we collected and analyzed data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort. We studied 7796 mothers enrolled in ALSPAC between 1991 and 1992 along with their children and partners. EXPOSURES Acetaminophen use was assessed by questionnaire completion at 18 and 32 weeks of pregnancy and when the child was 61 months old. MAIN OUTCOMES AND MEASURES Maternal reports of behavioral problems using the Strengths and Difficulties Questionnaire (SDQ) when the children were 7 years old. We estimated risk ratios for behavioral problems in children after prenatal, postnatal, and partner's exposure to acetaminophen and mutually adjusted each association. RESULTS Maternal prenatal acetaminophen use at 18 (n = 4415; 53%) and 32 weeks of pregnancy (n = 3381; 42%) was associated with higher odds of having conduct problems (risk ratio [RR], 1.42; 95% CI, 1.25-1.62) and hyperactivity symptoms (RR, 1.31; 95% CI, 1.16-1.49), while maternal acetaminophen use at 32 weeks was also associated with higher odds of having emotional symptoms (RR, 1.29; 95% CI, 1.09-1.53) and total difficulties (RR, 1.46; 95% CI, 1.21-1.77). This was not the case for maternal postnatal (n = 6916; 89%) or partner's (n = 3454; 84%) acetaminophen use. We found the associations between maternal prenatal acetaminophen use and all the SDQ domains unchanged even after adjusting for maternal postnatal or partner's acetaminophen use. CONCLUSIONS AND RELEVANCE Children exposed to acetaminophen prenatally are at increased risk of multiple behavioral difficulties, and the associations do not appear to be explained by unmeasured behavioral or social factors linked to acetaminophen use insofar as they are not observed for postnatal or partner's acetaminophen use. Although these results could have implications for public health advice, further studies are required to replicate the findings and to understand mechanisms.
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Affiliation(s)
- Evie Stergiakouli
- Medical Research Council (MRC) Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, United Kingdom
| | - Anita Thapar
- Institute of Psychological Medicine and Clinical Neurosciences, Medical Research Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, Wales
| | - George Davey Smith
- Medical Research Council (MRC) Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, United Kingdom
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145
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Fisher BG, Thankamony A, Hughes IA, Ong KK, Dunger DB, Acerini CL. Prenatal paracetamol exposure is associated with shorter anogenital distance in male infants. Hum Reprod 2016; 31:2642-2650. [PMID: 27609981 PMCID: PMC5088633 DOI: 10.1093/humrep/dew196] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/18/2016] [Accepted: 07/15/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the relationship between maternal paracetamol intake during the masculinisation programming window (MPW, 8-14 weeks of gestation) and male infant anogenital distance (AGD), a biomarker for androgen action during the MPW? SUMMARY ANSWER Intrauterine paracetamol exposure during 8-14 weeks of gestation is associated with shorter AGD from birth to 24 months of age. WHAT IS ALREADY KNOWN The increasing prevalence of male reproductive disorders may reflect environmental influences on foetal testicular development during the MPW. Animal and human xenograft studies have demonstrated that paracetamol reduces foetal testicular testosterone production, consistent with reported epidemiological associations between prenatal paracetamol exposure and cryptorchidism. STUDY DESIGN, SIZE, DURATION Prospective cohort study (Cambridge Baby Growth Study), with recruitment of pregnant women at ~12 post-menstrual weeks of gestation from a single UK maternity unit between 2001 and 2009, and 24 months of infant follow-up. Of 2229 recruited women, 1640 continued with the infancy study after delivery, of whom 676 delivered male infants and completed a medicine consumption questionnaire. PARTICIPANTS/MATERIALS, SETTING, METHOD Mothers self-reported medicine consumption during pregnancy by a questionnaire administered during the perinatal period. Infant AGD (measured from 2006 onwards), penile length and testicular descent were assessed at 0, 3, 12, 18 and 24 months of age, and age-specific Z scores were calculated. Associations between paracetamol intake during three gestational periods (<8 weeks, 8-14 weeks and >14 weeks) and these outcomes were tested by linear mixed models. Two hundred and twenty-five (33%) of six hundred and eighty-one male infants were exposed to paracetamol during pregnancy, of whom sixty-eight were reported to be exposed during 8-14 weeks. AGD measurements were available for 434 male infants. MAIN RESULTS AND THE ROLE OF CHANCE Paracetamol exposure during 8-14 weeks of gestation, but not any other period, was associated with shorter AGD (by 0.27 SD, 95% CI 0.06-0.48, P = 0.014) from birth to 24 months of age. This reduction was independent of body size. Paracetamol exposure was not related to penile length or testicular descent. LIMITATIONS, REASONS FOR CAUTION Confounding by other drugs or endocrine-disrupting chemicals cannot be discounted. The cohort was not fully representative of pregnant women in the UK, particularly in terms of maternal ethnicity and smoking prevalence. There is likely to have been misclassification of paracetamol exposure due to recall error. WIDER IMPLICATIONS OF THE FINDINGS Our observational findings support experimental evidence that intrauterine paracetamol exposure during the MPW may adversely affect male reproductive development. STUDY FUNDING/COMPETING INTERESTS This work was supported by a European Union Framework V programme, the World Cancer Research Fund International, the Medical Research Council (UK), the Newlife Foundation for Disabled Children, the Evelyn Trust, the Mothercare Group Foundation, Mead Johnson Nutrition, and the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre. The authors declare no conflict of interest.
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Affiliation(s)
- B G Fisher
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - A Thankamony
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - K K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.,MRC Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - D B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - C L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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146
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Wells RE, Turner DP, Lee M, Bishop L, Strauss L. Managing Migraine During Pregnancy and Lactation. Curr Neurol Neurosci Rep 2016; 16:40. [PMID: 27002079 DOI: 10.1007/s11910-016-0634-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
While over half of women with migraine report improvement during pregnancy, having a history of migraine may increase the chance of negative health outcomes. The state of pregnancy increases the risk of several dangerous secondary headache disorders, especially those associated with hypertensive disorders of pregnancy, and providers need to know the red flags to diagnose and treat emergently. Non-pharmacological migraine treatments can be instituted in advance of pregnancy as many are considered the safest options during pregnancy, but understanding the safety of medications and dietary supplements ensures appropriate care for the refractory migraine patient. New controversy exists over the safety of several historically routine and safe migraine treatment options in pregnancy, such as magnesium, acetaminophen, ondansetron, and butalbital. While it is not clear if breastfeeding decreases the postpartum recurrence of migraine, understanding safe treatment options during lactation can allow women to continue breastfeeding while achieving migraine relief.
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Affiliation(s)
- Rebecca Erwin Wells
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Dana P Turner
- Department of Anesthesiology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Michelle Lee
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Laura Bishop
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Lauren Strauss
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
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147
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Smarr MM, Grantz KL, Sundaram R, Maisog JM, Honda M, Kannan K, Buck Louis GM. Urinary paracetamol and time-to-pregnancy. Hum Reprod 2016; 31:2119-27. [PMID: 27412248 DOI: 10.1093/humrep/dew172] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
STUDY QUESTION Is preconception urinary paracetamol (acetaminophen) associated with time-to-pregnancy (TTP)? SUMMARY ANSWER Higher urinary paracetamol concentrations among male partners were associated with a longer TTP. WHAT IS KNOWN ALREADY Paracetamol is a commonly used analgesic among women and men of all ages. As metabolites of select chemicals used in the manufacturing of polyurethane foam, dyes and various industrial products, as well as a common medicinal product, paracetamol and its primary metabolite p-aminophenol, are ubiquitous in the environment. Studies investigating the relationship between adult urinary concentrations of paracetamol and TTP are lacking. STUDY DESIGN, SIZE, DURATION This prospective cohort included 501 couples discontinuing contraception for the purposes of attempting conception during the years 2005-2009 and residing in Michigan or Texas, USA. PARTICIPANTS/MATERIALS, SETTING, METHODS Total urinary paracetamol, its metabolite para-aminophenol (p-aminophenol), and a summary measure of both urinary biomarkers were quantified by ultra-performance liquid chromatography coupled with an electrospray triple quadrupole mass spectrometry (UPLC-ESI-MS/MS). Female partners used the Clearblue® digital home test to confirm pregnancy. Cox's proportional odds models for discrete survival time were used to estimate fecundability odds ratios (FORs) and 95% confidence intervals (CIs), adjusting for age, body mass index (BMI), urinary creatinine, preconception smoking status, race/ethnicity and household income. Models were further adjusted for hypothyroidism and hypertension as an attempt to account for possible indications of paracetamol medication use. FOR estimates <1.0 denote a longer TTP (diminished fecundity). Models were performed to examine urinary concentrations of paracetamol as a continuous and variable or categorized into quartiles. In light of TTP being a couple-dependent outcome, models were first performed for females and males, modeled separately, and then modeled for couples with each partner's concentrations being adjusted for the other. MAIN RESULTS AND THE ROLE OF CHANCE Among the 501 enrolled couples, 347 (69%) had an human chorionic gonadotrophin confirmed pregnancy. Urinary concentrations of paracetamol were lowest among females and males who achieved pregnancy and p-aminophenol concentrations were lowest among those not achieving pregnancy. Urinary paracetamol concentrations were higher among female than male partners (Median = 26.6 and 13.2 ng/ml, respectively; P < 0.0001). After adjustment for age, BMI, urinary creatinine, preconception smoking status, race/ethnicity and household income, the highest quartile of male urinary paracetamol was associated with a longer TTP [FOR = 0.67; 95% CI = (0.47, 0.95)]. This association remained after adjustment for chronic health conditions, hypothyroidism and hypertension and female partner's urinary paracetamol concentration [FOR = 0.65; 95% CI = (0.45, 0.94)]. No associations were observed between female or male partners' urinary concentrations of paracetamol or of its metabolite p-aminophenol when urinary concentrations were modeled continuously. LIMITATIONS, REASONS FOR CAUTION Only a single spot urine was available for analysis despite the short-lived nature of paracetamol. Additionally, participants were not asked to provide information on indication of use for paracetamol medications; any underlying conditions for the paracetamol use would have been potential confounders. WIDER IMPLICATIONS OF THE FINDINGS If corroborated with more robust studies, findings from our exploratory analysis may have both clinical and public health relevance among reproductive aged individuals, including those trying for pregnancy, given the prevalent use of paracetamol/acetaminophen medications and the ubiquitous nature of paracetamol in the environment. STUDY FUNDING/COMPETING INTERESTS This research was supported by the National Institutes of Health, Intramural Research Program, and Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts N01-HD-3-3355; N01-HD-3-3356; NOH-HD-3-3358; HHSN27500001/HHSN27500001). None of the authors have any conflicts to declare.
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Affiliation(s)
- Melissa M Smarr
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd., Room 7B05, Rockville, MD 20852, USA
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA
| | - Rajeshwari Sundaram
- Biostatics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA
| | - José M Maisog
- Glotech, Inc., Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA
| | - Masato Honda
- Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY 12201, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health, and Department of Environmental Health Sciences, School of Public Health, State University of New York at Albany, Albany, NY 12201, USA
| | - Germaine M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd., Room 7B05, Rockville, MD 20852, USA
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Kristensen DM, Mazaud-Guittot S, Gaudriault P, Lesné L, Serrano T, Main KM, Jégou B. Analgesic use - prevalence, biomonitoring and endocrine and reproductive effects. Nat Rev Endocrinol 2016; 12:381-93. [PMID: 27150289 DOI: 10.1038/nrendo.2016.55] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Paracetamol and NSAIDs, in particular acetylsalicylic acid (aspirin) and ibuprofen, are among the most used and environmentally released pharmaceutical drugs. The differences in international trends in the sale and consumption of mild analgesics reflect differences in marketing, governmental policies, habits, accessibility, disease patterns and the age distribution of each population. Biomonitoring indicates ubiquitous and high human exposure to paracetamol and to salicylic acid, which is the main metabolite of acetylsalicylic acid. Furthermore, evidence suggests that analgesics can have endocrine disruptive properties capable of altering animal and human reproductive function from fetal life to adulthood in both sexes. Medical and public awareness about these health concerns should be increased, particularly among pregnant women.
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Affiliation(s)
- David M Kristensen
- Genomic and Molecular Biomedicine, Department of Biology, University of Copenhagen, Ole Maaløes Vej 5, DK-2200 Copenhagen N, Denmark
| | - Séverine Mazaud-Guittot
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
| | - Pierre Gaudriault
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
| | - Laurianne Lesné
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
| | - Tania Serrano
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
- Ecole des hautes études en santé publique (EHESP), Avenue Léon Bernard, F-35043 RENNES, France
| | - Katharina M Main
- Department of Growth and Reproduction, University of Copenhagen, Section GR5064, Blegdamsvej 9, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Bernard Jégou
- Institut national de la santé et de la recherche médicale (Inserm), Institut de recherche en santé, environnement et travail (Irset-Inserm UMR 1085), 9 Avenue Léon Bernard, F-35042 RENNES, France
- Ecole des hautes études en santé publique (EHESP), Avenue Léon Bernard, F-35043 RENNES, France
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149
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Philippot G, Nyberg F, Gordh T, Fredriksson A, Viberg H. Short-term exposure and long-term consequences of neonatal exposure to Δ9-tetrahydrocannabinol (THC) and ibuprofen in mice. Behav Brain Res 2016; 307:137-44. [DOI: 10.1016/j.bbr.2016.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 01/19/2023]
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150
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Beigi RH, Noguchi L, Brown G, Piper J, Watts DH. Performing Drug Safety Research During Pregnancy and Lactation: Biomedical HIV Prevention Research as a Template. J Womens Health (Larchmt) 2016; 25:761-6. [PMID: 23808668 PMCID: PMC4939378 DOI: 10.1089/jwh.2013.4398] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Evidence-based guidance regarding use of nearly all pharmaceuticals by pregnant and lactating women is limited. Models for performing research may assist in filling these knowledge gaps. Internationally, reproductive age women are at high risk of human immunodeficiency virus (HIV) acquisition. Susceptibility to HIV infection may be increased during pregnancy, and risk of maternal-child transmission is increased with incident HIV infection during pregnancy and lactation. A multidisciplinary meeting of experts was convened at the United States National Institutes of Health to consider paradigms for drug research in pregnancy and lactation applicable to HIV prevention. This report summarizes the meeting proceedings and describes a framework for research on candidate HIV prevention agent use during pregnancy and lactation that may also have broader applications to other pharmaceutical products.
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Affiliation(s)
- Richard H. Beigi
- Division of Reproductive Infectious Diseases, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Microbicide Trials Network, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
| | - Lisa Noguchi
- Microbicide Trials Network, Magee-Womens Research Institute, Pittsburgh, Pennsylvania
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Gina Brown
- Office of AIDS Research, National Institutes of Health, Bethesda, Maryland
| | - Jeanna Piper
- National Institute of Allergy and Infectious Diseases, Division of AIDS, National Institutes of Health, Bethesda, Maryland
| | - D. Heather Watts
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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