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Park YJ, Park KH, Woo SJ. Clinical Features of Pregnancy-associated Retinal and Choroidal Diseases Causing Acute Visual Disturbance. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:320-327. [PMID: 28752697 PMCID: PMC5540987 DOI: 10.3341/kjo.2016.0080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 09/06/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report clinical features of patients with retinal and choroidal diseases presenting with acute visual disturbance during pregnancy. METHODS In this retrospective case series, patients who developed acute visual loss during pregnancy (including puerperium) and visited a tertiary hospital from July 2007 to June 2015, were recruited by searching electronic medical records. Patients were categorized according to the cause of visual loss. Clinical features and required diagnostic modalities were analyzed in the retinal and choroidal disease group. RESULTS Acute visual loss occurred in 147 patients; 49 (38.9%) were classified into the retinal and choroidal group. The diagnoses included central serous chorioretinopathy (22.4%), hypertensive retinopathy with or without pre-eclampsia (22.4%), retinal tear with or without retinal detachment (18.4%), diabetic retinopathy progression (10.2%), Vogt-Koyanagi-Harada disease (4.1%), retinal artery occlusion (4.1%), multiple evanescent white dot syndrome (4.1%), and others (14.3%). Visual symptoms first appeared at gestational age 25.9 ± 10.3 weeks. The initial best-corrected visual acuity (BCVA) was 0.27 ± 0.39 logarithm of the minimum angle of resolution (logMAR); the final BCVA after delivery improved to 0.13 ± 0.35 logMAR. Serious visual deterioration (BCVA worth than 20 / 200) developed in two patients. Differential diagnoses were established with characteristic fundus and spectral-domain optical coherence tomography findings in all cases. CONCLUSIONS In pregnant women with acute visual loss, retinal and choroidal diseases are common and could be vision threatening. Physicians should be aware of pregnancy-associated retinal and choroidal diseases and their clinical features. The differential diagnosis can be established with non-invasive techniques.
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Affiliation(s)
- Young Joo Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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152
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A cost-effectiveness analysis of maternal CYP2D6 genetic testing to guide treatment for postpartum pain and avert infant adverse events. THE PHARMACOGENOMICS JOURNAL 2017; 18:391-397. [PMID: 28696420 DOI: 10.1038/tpj.2017.33] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 11/08/2022]
Abstract
Mothers with a CYP2D6 ultrarapid metabolizer phenotype may expose their infants to risk of adverse events when taking codeine while breastfeeding, by producing more of the active metabolite, morphine. Pharmacogenetic testing may be a valuable tool to identify such mothers, but testing can be costly. The objective of the study was to determine the incremental costs of genotyping to avert neonatal adverse events during maternal pharmacotherapy. A cost-effectiveness analysis, using a decision model, was performed with a hypothetical cohort of prenatal subjects. Parameter estimates, costs and ranges for sensitivity analyses were ascertained from the literature and expert opinion. Sensitivity analyses were conducted to assess the robustness of the results. Probabilistic sensitivity analysis revealed an incremental cost-effectiveness (ICER) of $10 433 (Canadian dollars) for genotyping compared to no genotyping per adverse event averted. Results were sensitive to hospital admission costs. The ICER was lower when evaluating only subjects having caesarean deliveries or those from ethnic populations known to have a high prevalence of ultra-rapid metabolizers. Although genotyping to guide pharmacotherapy was not cost saving, the cost to avert an infant adverse event may represent good value for money in specific populations. With a growing demand for personalized medicine, these findings are relevant for decision makers, clinicians and patients.
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153
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Dumas A, Toutain S, Simmat-Durand L. Alcohol Use During Pregnancy or Breastfeeding: A National Survey in France. J Womens Health (Larchmt) 2017; 26:798-805. [DOI: 10.1089/jwh.2016.6130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Sud, Orsay, France
| | - Stéphanie Toutain
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société (CERMES3), UMR CNRS 8211, INSERM U988, EHESS, Paris, France
| | - Laurence Simmat-Durand
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société (CERMES3), UMR CNRS 8211, INSERM U988, EHESS, Paris, France
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154
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Reddy UM, Davis JM, Ren Z, Greene MF. Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes: Executive Summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Maternal-Fetal Medicine, Centers for Disease Control and Prevention, and the March of Dimes Foundation. Obstet Gynecol 2017; 130:10-28. [PMID: 28594753 PMCID: PMC5486414 DOI: 10.1097/aog.0000000000002054] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In April 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development invited experts to a workshop to address numerous knowledge gaps and to review the evidence for the screening and management of opioid use in pregnancy and neonatal abstinence syndrome. The rising prevalence of opioid use in pregnancy has led to a concomitant dramatic fivefold increase in neonatal abstinence syndrome over the past decade. Experts from diverse disciplines addressed research gaps in the following areas: 1) optimal screening for opioid use in pregnancy; 2) complications of pregnancy associated with opioid use; 3) appropriate treatments for pregnant women with opioid use disorders; 4) the best approaches for detecting, treating, and managing newborns with neonatal abstinence syndrome; and 5) the long-term effects of prenatal opioid exposure on children. Workshop participants identified key scientific opportunities to advance the understanding of opioid use disorders in pregnancy and to improve outcomes for affected women, their children, and their families. This article provides a summary of the workshop presentations and discussions.
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Affiliation(s)
- Uma M Reddy
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, the Tufts University School of Medicine, Boston, Massachusetts, and the Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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155
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Treat androgenetic alopecia with antiandrogens, as well as other pharmacological and non-pharmacological interventions. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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156
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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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157
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Karra N, Cohen R, Berlin M, Dinavitser N, Koren G, Berkovitch M. Safety of Mebendazole Use During Lactation: A Case Series Report. Drugs R D 2017; 16:251-254. [PMID: 27623793 PMCID: PMC5045833 DOI: 10.1007/s40268-016-0142-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Mebendazole is an effective drug widely used in the treatment of parasitic infections. Although theoretically considered as safe during lactation, no studies have evaluated its potential adverse effects in infants of breastfeeding mothers. Objectives We aimed to evaluate the safety of mebendazole in infants of lactating women treated with the drug. Methods Women referred for consultation regarding mebendazole use were invited to participate in the study. Overall 45 lactating women treated with various protocols of mebendazole were recruited in this case series study. Results Regardless of the treatment protocol used (single or repeated doses) mebendazole was well tolerated and was not associated with any adverse effects in infants of lactating mothers. There was mild GI irritability in two treated women. Conclusion This study provides first evidence in humans as to the safety of mebendazole in breastfeeding. Electronic supplementary material The online version of this article (doi:10.1007/s40268-016-0142-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nour Karra
- The Motherisk Program, Zerifin, Israel. .,Clinical Pharmacology Unit, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.
| | - Rana Cohen
- The Motherisk Program, Zerifin, Israel.,Clinical Pharmacology Unit, Assaf Harofeh Medical Center, 70300, Zerifin, Israel
| | - Maya Berlin
- Clinical Pharmacology Unit, Assaf Harofeh Medical Center, 70300, Zerifin, Israel
| | - Natalie Dinavitser
- Clinical Pharmacology Unit, Assaf Harofeh Medical Center, 70300, Zerifin, Israel
| | - Gideon Koren
- The Motherisk Program, Zerifin, Israel.,The Motherisk Program, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Matitiahu Berkovitch
- The Motherisk Program, Zerifin, Israel.,Clinical Pharmacology Unit, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.,Affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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158
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European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol 2017; 101:130-195. [PMID: 28559477 PMCID: PMC5583689 DOI: 10.1136/bjophthalmol-2016-egsguideline.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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159
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Perng P, Zampella JG, Okoye GA. Management of hidradenitis suppurativa in pregnancy. J Am Acad Dermatol 2017; 76:979-989. [DOI: 10.1016/j.jaad.2016.10.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 12/16/2022]
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160
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Katz D, Beilin Y. Review of the Alternatives to Epidural Blood Patch for Treatment of Postdural Puncture Headache in the Parturient. Anesth Analg 2017; 124:1219-1228. [DOI: 10.1213/ane.0000000000001840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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161
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Abstract
Androgenetic alopecia (AGA) is characterized by a non-scarring progressive miniaturization of the hair follicle in predisposed men and women with a pattern distribution. Although AGA is a very prevalent condition, approved therapeutic options are limited. This article discusses the current treatment alternatives including their efficacy, safety profile, and quality of evidence. Finasteride and minoxidil for male androgenetic alopecia and minoxidil for female androgenetic alopecia still are the therapeutic options with the highest level evidence. The role of antiandrogens for female patients, the importance of adjuvant therapies, as well as new drugs and procedures are also addressed.
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Affiliation(s)
- Yanna Kelly
- Department of Dermatology, Universidade de São Paulo, São Paulo, SP, Brazil. .,Department of Dermatology, Hospital do Servidor Publico Municipal de São Paulo, São Paulo, SP, Brazil. .,, 1364, Oscar Freire Street, São Paulo, SP, 05409-010, Brazil.
| | - Aline Blanco
- Department of Dermatology, Universidade Federal do Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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162
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Özen S, Batu ED, Demir S. Familial Mediterranean Fever: Recent Developments in Pathogenesis and New Recommendations for Management. Front Immunol 2017; 8:253. [PMID: 28386255 PMCID: PMC5362626 DOI: 10.3389/fimmu.2017.00253] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/21/2017] [Indexed: 01/05/2023] Open
Abstract
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease (AID) affecting mainly the ethnic groups originating from Mediterranean basin. The disease is characterized by self-limited inflammatory attacks of fever and polyserositis along with elevated acute phase reactants. FMF is inherited autosomal recessively; however, a significant proportion of heterozygotes also express the phenotype. FMF is caused by mutations in the MEFV gene coding for pyrin, which is a component of inflammasome functioning in inflammatory response and production of interleukin-1β (IL-1β). Recent studies have shown that pyrin recognizes bacterial modifications in Rho GTPases, which results in inflammasome activation and increase in IL-1β. Pyrin does not directly recognize Rho modification but probably affected by Rho effector kinase, which is a downstream event in the actin cytoskeleton pathway. Recently, an international group of experts has published the recommendations for the management of FMF. Colchicine is the mainstay of FMF treatment, and its regular use prevents attacks and controls subclinical inflammation in the majority of patients. Furthermore, it decreases the long-term risk of amyloidosis. However, a minority of FMF patients fail to response or tolerate colchicine treatment. Anti-interleukin-1 drugs could be considered in these patients. One should keep in mind the possibility of non-compliance in colchicine-non-responders. Although FMF is a relatively well-described AID and almost 20 years has passed since the discovery of the MEFV gene, there are still a number of unsolved problems about it such as the exact mechanism of the disease, symptomatic heterozygotes and their treatment, and the optimal management of colchicine resistance.
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Affiliation(s)
- Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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163
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Abstract
While much of the existing literature in the field of reproductive rheumatology focuses on fertility, preconception counseling, and pregnancy, there is limited information regarding the postpartum period and lactation. Evidence suggests that many rheumatologic disorders flare after delivery, which, along with limitations in medications compatible with breastfeeding, make this time period challenging for women with rheumatologic conditions. This article discusses rheumatologic disease activity during the postpartum period and reviews the safety during lactation of commonly used medications for the management of rheumatic diseases. Fortunately, many of the commonly used medications are compatible with breastfeeding.
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164
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Abstract
Cesarean delivery rates are increasing worldwide, and effective postoperative pain management is a key priority of women undergoing cesarean delivery. Inadequate pain management in the acute postoperative period is associated with persistent pain, greater opioid use, delayed functional recovery, and increased postpartum depression. In addition to pain relief, optimal management of patients after cesarean delivery should address the goals of unrestricted maternal mobility, minimal maternal and neonatal side effects, rapid recovery to baseline functionality, and early discharge home. Multimodal analgesia should include neuraxial morphine in conjunction with nonopioid adjuncts, with additional oral or intravenous opioids reserved for severe breakthrough pain.
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Affiliation(s)
- Caitlin Dooley Sutton
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
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165
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Abd Rahman R, DeKoninck P, Murthi P, Wallace EM. Treatment of preeclampsia with hydroxychloroquine: a review. J Matern Fetal Neonatal Med 2017; 31:525-529. [DOI: 10.1080/14767058.2017.1289511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rahana Abd Rahman
- Department of Obstetrics and Gynecology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Philip DeKoninck
- Department of Medicine, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Padma Murthi
- Department of Medicine, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - Euan M. Wallace
- Department of Medicine, School of Clinical Sciences, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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166
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Spiesser-Robelet L, Brunie V, de Andrade V, Gagnayre R. Knowledge, Representations, Attitudes, and Behaviors of Women Faced With Taking Medications While Breastfeeding. J Hum Lact 2017; 33:98-114. [PMID: 28027444 DOI: 10.1177/0890334416679383] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Breastfeeding is a major public health issue in terms of its benefits to both mothers and infants. Despite recommendations, breastfeeding initiation and duration are low in many industrialized countries. Although human milk is viewed as the most appropriate food for infants, when it is perceived as contaminated, doubts about its quality can lead to negative behaviors concerning breastfeeding. This is especially true when mothers are taking medication. Research aim: The aim of this review is to evaluate the data in the literature on the knowledge, representations, attitudes, and behaviors of women with regard to taking medication while breastfeeding. These elements should aid our understanding of how the mothers' behaviors are constructed in this situation. METHODS The authors conducted a scoping review to map and analyze the available data from literature sources regarding breastfeeding mothers' knowledge, representations, attitudes, and behaviors about medicines. A staged approach to the scoping review was used. RESULTS Eighteen studies met the selection criteria. They described safety behaviors like noninitiation, duration reduction, breastfeeding cessation, and refusal to take medication in order to breastfeed. Most showed a conflict between taking medication and breastfeeding. Because the knowledge, representations, and attitudes behind such behaviors have received very little study, it is difficult to explain how these behaviors are constructed. CONCLUSION The results of this review confirm the need for a qualitative study to explore the knowledge, representations, and attitudes of breastfeeding women faced with taking medications, so that we can understand their connection with observed behaviors and take appropriate educational action.
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Affiliation(s)
- Laurence Spiesser-Robelet
- 1 Health Education and Practices Laboratory-LEPS (EA 3412), Université Paris13-Sorbonne Paris Cité, Bobigny, France.,2 Service Pharmacie, CHU d'Angers, 49933 Angers cedex 9, France
| | - Vanida Brunie
- 1 Health Education and Practices Laboratory-LEPS (EA 3412), Université Paris13-Sorbonne Paris Cité, Bobigny, France.,3 Pharmacie, Hôpitaux Universitaires Henri Mondor, APHP, Limeil-Brévannes, France
| | - Vincent de Andrade
- 1 Health Education and Practices Laboratory-LEPS (EA 3412), Université Paris13-Sorbonne Paris Cité, Bobigny, France
| | - Rémi Gagnayre
- 1 Health Education and Practices Laboratory-LEPS (EA 3412), Université Paris13-Sorbonne Paris Cité, Bobigny, France
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167
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Fountoulakis KN, Grunze H, Vieta E, Young A, Yatham L, Blier P, Kasper S, Moeller HJ. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 3: The Clinical Guidelines. Int J Neuropsychopharmacol 2017; 20:180-195. [PMID: 27941079 PMCID: PMC5408976 DOI: 10.1093/ijnp/pyw109] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/20/2016] [Accepted: 11/29/2016] [Indexed: 02/05/2023] Open
Abstract
Background The current paper introduces the actual International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder. Concept and structure of the guidelines The current clinical guidelines are based on evidence-based data, but they also intend to be clinically useful, while a rigid algorithm was developed on the basis of firm evidence alone. Monotherapy was prioritized over combination therapy. There are separate recommendations for each of the major phases of bipolar disorder expressed as a 5-step algorithm. Discussion The current International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder are the most up-to-date guidance and are as evidence based as possible. They also include recommendations concerning the use of psychotherapeutic interventions, again on the basis of available evidence. This adherence of the workgroup to the evidence in a clinically oriented way helped to clarify the role of specific antidepressants and traditional agents like lithium, valproate, or carbamazepine. The additional focus on specific clinical characteristics, including predominant polarity, mixed features, and rapid cycling, is also a novel approach. Many issues need further studies, data are sparse and insufficient, and many questions remain unanswered. The most important and still unmet need is to merge all the guidelines that concern different phases of the illness into a single one and in this way consider BD as a single unified disorder, which is the real world fact. However, to date the research data do not permit such a unified approach.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
| | - Heinz Grunze
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
| | - Eduard Vieta
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
| | - Allan Young
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
| | - Lakshmi Yatham
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
| | - Pierre Blier
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
| | - Siegfried Kasper
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
| | - Hans Jurgen Moeller
- 3rd Department of Psychiatry, School of Medicine, Aristotle University, Thessaloniki, Greece; Paracelsus Medical University, Salzburg, Austria; Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, University of British Columbia, Mood Disorders Centre of Excellence, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada; The Royal Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Department of Psychiatry and Psychotherapy, Medical University Vienna, MUV, AKH, Vienna, Austria; Psychiatric Department, Ludwig Maximilians University, Munich, Germany
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Mehta TM, Van Lieshout RJ. A review of the safety of clozapine during pregnancy and lactation. Arch Womens Ment Health 2017; 20:1-9. [PMID: 27704220 DOI: 10.1007/s00737-016-0670-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/19/2016] [Indexed: 11/26/2022]
Abstract
Clozapine is an antipsychotic used in the management of treatment-resistant schizophrenia. However, little is known about clozapine use during pregnancy and lactation, or its impact on the mother, foetus, and infant. This review aims to summarize the available literature on the safety of clozapine use during the perinatal period. EMBASE, PsycINFO, and MEDLINE were searched from their inceptions through June 2016. The review encompasses 21 studies that have examined clozapine use during pregnancy and lactation. The limited available data do not support an increased risk of congenital malformations in foetuses exposed to clozapine during pregnancy, though rates of gestational diabetes are twice as high in pregnant women using clozapine. Clozapine accumulation in foetal serum possibly contributes to increased rates of floppy infant syndrome at delivery, decreased foetal heart rate variability, and seizures in infancy. Clozapine crosses the placenta and also accumulates in breast milk, which may increase the risk of agranulocytosis in infants and may necessitate infant testing. The majority of these data come from case reports and case series, making it unclear if the published risks associated with clozapine are due to mental illness, lifestyle factors, or co-treatment with other psychotropic medications. While the available literature on clozapine use during the perinatal period is very limited, the risks of clozapine use during pregnancy and the postpartum period should be discussed with women and weighed against those associated with other treatments and partially or untreated schizophrenia.
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Affiliation(s)
- Taylor M Mehta
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Women's Health Concerns Clinic, St. Joseph's Hospital, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
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170
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Peripartum Cardiomyopathy: Do Exosomes Play a Role? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 998:139-149. [PMID: 28936737 DOI: 10.1007/978-981-10-4397-0_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Peripartum cardiomyopathy (PPCM) refers to irreversible cardiomyocyte damage that occurs during the last month of pregnancy, or within 5 months after giving birth. It is characterized by systolic heart failure. This life-threatening condition is relatively uncommon, but the incidence has been climbing up. Because of its high mortality, it is crucial for physicians to have high suspicious for the disease. Studies have been done to search into specific lab test and treatment for PPCM. Therapies like anti-viral, anti-inflammatory and immunosuppression regimen have been explored. New regimen like exosomes has also been explored and revealed promising effects.
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Kim YH, Lee SM, Kim MA, Yang HJ, Choi JH, Kim DK, Yoo Y, Kim BS, Kim WY, Kim JH, Park SY, Song K, Yang MS, Lee YM, Lee HJ, Cho JH, Jee HM, Park Y, Bae WY, Koh YI. Clinical diagnostic guidelines of allergic rhinitis: comprehensive treatment and consideration of special circumstances. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.3.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Young Hyo Kim
- Department of Otorhinolaryngology, Inha University College of Medicine, Incheon, Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University College of Medicine, Seoul, Korea
- SCH Biomedical Informatics Research Unit, Seoul, Korea
| | - Jeong-Hee Choi
- Department of Pulmonology and Allergy, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Allergy Immunology Center, Korea University, Seoul, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | | | - Jeong Hee Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | | | - Keejae Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong Universtiy College of Medicine, Incheon, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | | | | | | | - Hye Mi Jee
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Yang Park
- Department of Pediatrics, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea
| | - Woo Yong Bae
- Department of Otorhinolaryngology, Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Young-Il Koh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, Francis GS, Lenihan D, Lewis EF, McNamara DM, Pahl E, Vasan RS, Ramasubbu K, Rasmusson K, Towbin JA, Yancy C. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e579-e646. [PMID: 27832612 DOI: 10.1161/cir.0000000000000455] [Citation(s) in RCA: 440] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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173
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Micronucleated Erythrocytes in Peripheral Blood from Neonate Rats Exposed by Breastfeeding to Cyclophosphamide, Colchicine, or Cytosine-Arabinoside. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9161648. [PMID: 28018917 PMCID: PMC5149595 DOI: 10.1155/2016/9161648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 01/16/2023]
Abstract
Genotoxic exposure to chemical substances is common, and nursing mothers could transmit harmful substances or their metabolites to their offspring through breast milk. We explored the possibility of determining genotoxic effects in the erythrocytes of breastfeeding rat pups whose mothers received a genotoxic compound while nursing. Ten groups of female rats and five pups per dam were studied. The control group received sterile water, and the experimental groups received one of three different doses of cyclophosphamide, colchicine, or cytosine-arabinoside. Blood smears were prepared from samples taken from each dam and pup every 24 h for six days. There were increased numbers of micronucleated erythrocytes (MNEs) and micronucleated polychromatic erythrocytes (MNPCEs) in the samples from pups in the experimental groups (P < 0.02) and increased MNPCE frequencies in the samples from the dams (P < 0.05). These results demonstrate the vertical transmission of the genotoxic effect of the compounds tested. In conclusion, assessing MNEs in breastfeeding neonate rats to assess DNA damage may be a useful approach for identifying genotoxic compounds and/or cytotoxic effects. This strategy could help in screening for therapeutic approaches that are genotoxic during the lactation stage and these assessments might also be helpful for developing preventive strategies to counteract harmful effects.
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174
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Napierala M, Mazela J, Merritt TA, Florek E. Tobacco smoking and breastfeeding: Effect on the lactation process, breast milk composition and infant development. A critical review. ENVIRONMENTAL RESEARCH 2016; 151:321-338. [PMID: 27522570 DOI: 10.1016/j.envres.2016.08.002] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/03/2016] [Accepted: 08/02/2016] [Indexed: 06/06/2023]
Abstract
Approximately 10% of women report smoking during pregnancy. The number of breastfeeding women who relapse back to smoking is even greater. Smoking may cause adverse changes to the milk's composition by not only reducing its protective properties, but also by affecting the infant's health. The pathophysiological mechanisms underlying these adverse effects are not entirely known. This article is a review of previous reports about the effects of smoking on the lactation process, breast milk composition and infant development. A systematic search for English language articles published until 2015 was made, using a MEDLINE data. The key search terms were "smoking and breastfeeding", "smoking and lactation", "smoking and milk composition", "nicotine and breast milk". Studies have shown that nicotine levels in breast milk of women who smoke are three times higher than those in the plasma levels. Breast milk volume is reduced and the duration of lactation period is shorter. Smoking causes adverse changes to the milk's composition by not only reducing its protective properties, but also affecting infants' response to breastfeeding and to breast milk.
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Affiliation(s)
- Marta Napierala
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland
| | - Jan Mazela
- Department of Neonatal Infection, Poznan University of Medical Sciences, 33 Polna Street, 60-535 Poznan, Poland
| | - T Allen Merritt
- Children's Hospital, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Ewa Florek
- Laboratory of Environmental Research, Department of Toxicology, Poznan University of Medical Sciences, 30 Dojazd Street, 60-631 Poznan, Poland.
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Abstract
PURPOSE OF REVIEW This article provides a systematic, evidence-based approach to acute medication choices for the patient with migraine. RECENT FINDINGS Recent clinical trials, meta-analyses, and practice guidelines have confirmed that four nonsteroidal anti-inflammatory drugs (NSAIDs) with randomized controlled trial evidence for efficacy in migraine (ibuprofen, naproxen sodium, diclofenac potassium, and acetylsalicylic acid) and seven triptans (sumatriptan, rizatriptan, eletriptan, zolmitriptan, almotriptan, frovatriptan, and naratriptan) are appropriate medications for acute migraine treatment. Dihydroergotamine (DHE) is also suitable for selected patients. SUMMARY NSAIDs and triptans are the mainstays of acute migraine therapy, and antiemetic drugs can be added as necessary. Opioids and combination analgesics containing opioids should not be used routinely. Patient-specific clinical features should help guide the selection of an acute medication for an individual patient. Acute medications can be organized into four treatment strategies for use in various clinical settings. The acetaminophen-NSAID strategy is suitable for patients with attacks of mild to moderate severity. The triptan strategy is suitable for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs. The refractory migraine strategies may be useful for patients who do not respond well to the NSAIDs or triptans alone and include using triptans and NSAIDs simultaneously in combination, DHE, and rescue medications (eg, dopamine antagonists, combination analgesics, and corticosteroids) when the patient's usual medications fail. Strategies for patients with contraindications to vasoconstricting drugs include use of NSAIDs, combination analgesics, and dopamine antagonists.Acetaminophen is the safest acute migraine drug during pregnancy, and acetaminophen with codeine is also an option. Sumatriptan may be an option during pregnancy for selected patients and is compatible with breast-feeding.
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176
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Pinder M, Lummis K, Selinger CP. Managing inflammatory bowel disease in pregnancy: current perspectives. Clin Exp Gastroenterol 2016; 9:325-335. [PMID: 27789969 PMCID: PMC5072556 DOI: 10.2147/ceg.s96676] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Inflammatory bowel disease (IBD) affects many women of childbearing age. The course of IBD is closely related to pregnancy outcomes with poorly controlled IBD increasing the risk of prematurity, low weight for gestation, and fetal loss. As such, women with IBD face complex decision making weighing the risks of active disease versus those of medical treatments. This review summarizes the current evidence regarding the safety and efficacy of IBD treatments during pregnancy and lactation aiming to provide up-to-date guidance for clinicians. Over 50% of women have poor IBD- and pregnancy-related knowledge, which is associated with views contrary to medical evidence and voluntary childlessness. This review highlights the effects of poor patient knowledge and critically evaluates interventions for improving patient knowledge and outcomes.
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Affiliation(s)
- Matthew Pinder
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust
| | - Katie Lummis
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust
| | - Christian P Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust; University of Leeds, Leeds, UK
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Does Breast Milk Affect Neonatal Abstinence Syndrome Severity, the Need for Pharmacologic Therapy, and Length of Stay for Infants of Mothers on Opioid Maintenance Therapy During Pregnancy? Adv Neonatal Care 2016; 16:369-378. [PMID: 27564423 DOI: 10.1097/anc.0000000000000330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The United States is in an opioid crisis with abuse among women on the rise over the past 10 years. Infants of opioid-dependent mothers are at risk for neonatal abstinence syndrome (NAS). Neonatal abstinence syndrome can affect multiple systems and disrupt normal growth and development. It is for this reason that strategies to promote health such as breastfeeding need to be explored. This brief evaluates current evidence regarding breast milk and the impact it has on NAS. PURPOSE The question guiding this brief is: "Does provision of breast milk reduce NAS withdrawal symptoms, decrease length of stay, and decrease the need for pharmacologic therapy for infants whose mothers are maintained on methadone or buprenorphine?" SEARCH STRATEGY CINHAL/MEDLINE Complete and PubMed databases were searched using key words-NAS and breastfeeding-and the search was limited to 10 years for English studies evaluating the effects of breast milk on severity of NAS, pharmacologic therapy, and length of stay whose mothers received methadone or buprenorphine during pregnancy. The search yielded 10 studies addressing these concerns. FINDINGS Breast milk may be beneficial for decreasing NAS severity, pharmacologic therapy, and length of stay. IMPLICATIONS FOR PRACTICE Strategies should be developed to support individualized plans based on maternal history, safety, and mother's choice. IMPLICATIONS FOR RESEARCH Further research is needed utilizing matched case-controlled studies regarding breast milk and the influence on severity of NAS, need for pharmacologic therapy, length of stay, and neurologic outcomes. In addition, other factors should be investigated including abrupt weaning, polysubstance use, and readmissions.
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178
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Tiwari S, Bharadva K, Yadav B, Malik S, Gangal P, Banapurmath CR, Zaka-Ur-Rab Z, Deshmukh U, Visheshkumar, Agrawal RK. Infant and young child feeding guidelines, 2016. Indian Pediatr 2016; 53:703-13. [DOI: 10.1007/s13312-016-0914-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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179
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D'Avila FB, Limberger RP, Fröehlich PE. Cocaine and crack cocaine abuse by pregnant or lactating mothers and analysis of its biomarkers in meconium and breast milk by LC–MS—A review. Clin Biochem 2016; 49:1096-103. [DOI: 10.1016/j.clinbiochem.2016.01.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 01/24/2016] [Accepted: 01/27/2016] [Indexed: 11/25/2022]
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180
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Al-Sawalha NA, Tahaineh L, Sawalha A, Almomani BA. Medication Use in Breastfeeding Women: A National Study. Breastfeed Med 2016; 11:386-91. [PMID: 27548275 DOI: 10.1089/bfm.2016.0044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION A wealth of evidence reveals the benefits of breastfeeding. During the breastfeeding period, nursing mothers may face many medical conditions that require medical management. The medication use among breastfeeding women in Jordan is largely unknown. OBJECTIVE This study assessed the beliefs and attitudes of breastfeeding women in Jordan toward medication use. METHODS The data were collected from breastfeeding women in hospitals and maternal and children care centers from north, middle, and south Jordan by semistructured interviews using a self-administered questionnaire from February 2015 to November 2015. RESULTS Of the 903 participants (96% response rate), 17% used over-the-counter medications and 33% took prescribed medications. Of these, 7% (n = 64) used both over-the-counter and prescribed medications. Analgesics followed by antibiotics were the most commonly used medications among breastfeeding women in Jordan. The majority of breastfeeding women consulted with their physician or pharmacist before initiating or changing any medication. Product Information was the most commonly used drug information resource utilized by breastfeeding women to inquire about safety of medication use during breastfeeding. CONCLUSION Breastfeeding women should be educated about the reliable sources of medication information and the importance of physician consultation before initiation or modification of medication therapy. Physicians and pharmacists should be encouraged to be actively involved in detailed discussion with breastfeeding women regarding medication use.
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Affiliation(s)
- Nour A Al-Sawalha
- Faculty of Pharmacy, Jordan University of Science and Technology , Irbid, Jordan
| | - Linda Tahaineh
- Faculty of Pharmacy, Jordan University of Science and Technology , Irbid, Jordan
| | - Abeer Sawalha
- Faculty of Pharmacy, Jordan University of Science and Technology , Irbid, Jordan
| | - Basima A Almomani
- Faculty of Pharmacy, Jordan University of Science and Technology , Irbid, Jordan
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181
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Salazar FR, D’Avila FB, de Oliveira MH, Ferreira PL, Bergold AM. Development and validation of a bioanalytical method for five antidepressants in human milk by LC–MS. J Pharm Biomed Anal 2016; 129:502-508. [DOI: 10.1016/j.jpba.2016.07.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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182
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Madadi P, Koren G, Cairns J, Chitayat D, Gaedigk A, Leeder JS, Teitelbaum R, Karaskov T. RETRACTED: Maternal Codeine is Not Safe for all Breast-Fed Infants. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350613900610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Parvaz Madadi
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
| | - Gideon Koren
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
| | - James Cairns
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
| | - David Chitayat
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
| | - Andrea Gaedigk
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
| | - J. Steven Leeder
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
| | - Ronni Teitelbaum
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
| | - Tatyana Karaskov
- This Motherisk question was prepared by the Motherisk Team at the Hospital for Sick
Children in Toronto, Ontario. Parvaz Madadi and Dr. Tatyana Karasov are members of
the Motherisk team. Dr. Gideon Koren is the director of the Motherisk team and holder
of the Ivey Chair in Molecular Toxicology at the University of Western Ontario. Dr.
James Cairns practices at the Ontario Coroner's Office. Dr. David Chitayat and Ronni
Teitelbaum
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183
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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: 38] [Impact Index Per Article: 4.8] [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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184
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Nice FJ, DeEugenio D, DiMino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part I. J Pharm Technol 2016. [DOI: 10.1177/875512250402000106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of common ambulatory care, analgesic, and anesthetic medications during breast-feeding. Data Sources: Primary texts used by the breast-feeding community were searched, as well as Micromedex, MEDLINE, PubMed, Embase, and Embase2 (1984–July 2003). Study Selection and Data Extraction: Multiple sources were utilized whenever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast feeding, lactation, nursing, and medications, as well as specific drug names. Data Synthesis: Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are medications that can be harmful to nursing infants, breast milk concentrations of most drugs are insufficient to cause any harm. Conclusions: Having objective and reliable information on medications enables pharmacists, pharmacy technicians, other healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
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Affiliation(s)
- Frank J Nice
- FRANK J NICE MS MPA DPA CPHP, Assistant Director, Clinical Neurosciences Program (CNP), National Institutes of Health (NIH), Bethesda, MD
| | - Deborah DeEugenio
- DEBORAH DeEUGENIO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Assistant Professor, School of Pharmacy, Temple University, Philadelphia, PA; Clinical Pharmacist, Jefferson Antithrombotics Therapy Service, Jefferson Heart Institute, Philadelphia, PA
| | - Traci A DiMino
- TRACI A DiMINO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Adverse Event Specialist, Global Safety Surveillance & Epidemiology, Wyeth, Collegeville, PA
| | - Ingrid C Freeny
- INGRID C FREENY PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Medical Student, Drexel University College of Medicine, Philadelphia, PA
| | - Marissa B Rovnack
- MARISSA B ROVNACK PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Clinical Staff Pharmacist, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Joseph S Gromelski
- JOSEPH S GROMELSKI PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Pharmacist, Walmart, Baltimore, MD; Law Student, University of Maryland, Baltimore
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Nice FJ, DeEugenio D, DiMino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part III. J Pharm Technol 2016. [DOI: 10.1177/875512250402000304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective:To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of antiinfectives, vaccines, antiepileptics, benzodiazepines, psychotherapeutic drugs, and radiopharmaceuticals during breast-feeding.Data Sources:Primary texts used by the breast-feeding community ( Medications and Mothers' Milk, Drugs in Pregnancy and Lactation, Drugs and Human Lactation) were searched, as well as Micromedex, MEDLINE, PubMed, EMBASE, and EMBASE2 (1984–February 2004).Study Selection/Data Extraction:Multiple sources were used wherever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast-feeding, lactation, nursing, and medications, as well as specific drug names.Data Synthesis:Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are drugs that can be harmful to nursing infants, breast-milk concentrations of most drugs are insufficient to cause any harm.Conclusions:Having objective and reliable information on medications enables pharmacists, pharmacy technicians, other healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
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Affiliation(s)
- Frank J Nice
- FRANK J NICE MS MPA DPA CPHP, Assistant Director, Clinical Neurosciences Program (CNP), National Institutes of Health (NIH), Bethesda, MD
| | - Deborah DeEugenio
- DEBORAH DeEUGENIO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Assistant Professor, School of Pharmacy, Temple University, Philadelphia, PA; Clinical Pharmacist, Jefferson Antithrombotics Therapy Service, Jefferson Heart Institute, Philadelphia
| | - Traci A DiMino
- TRACI A DiMINO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Adverse Event Specialist, Global Safety Surveillance & Epidemiology, Wyeth, Collegeville, PA
| | - Ingrid C Freeny
- INGRID C FREENY PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Medical Student, Drexel University College of Medicine, Philadelphia
| | - Marissa B Rovnack
- MARISSA B ROVNACK PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Clinical Staff Pharmacist, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Joseph S Gromelski
- JOSEPH S GROMELSKI PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Pharmacist, Walmart, Baltimore, MD; Law Student, University of Maryland, Baltimore
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Nice FJ, DeEugenio D, DiMino TA, Freeny IC, Rovnack MB, Gromelski JS. Medications and Breast-Feeding: A Guide for Pharmacists, Pharmacy Technicians, and other Healthcare Professionals Part II. J Pharm Technol 2016. [DOI: 10.1177/875512250402000205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To provide a guide for practicing pharmacists, pharmacy technicians, and other healthcare professionals so that they are able to counsel and advise breast-feeding mothers and fellow healthcare professionals on the safety and use of common cardiology and general medications during breast-feeding. Data Sources: Primary texts used by the breast-feeding community ( Medications and Mothers' Milk, Drugs in Pregnancy and Lactation, Drugs and Human Lactation) were searched, as well as Micromedex, MEDLINE, PubMed, EMBASE, and EMBASE2 (1984–February 2004). Study Selection/Data Extraction: Multiple sources were used wherever available to validate the data, and primary articles were used to verify all tertiary source information. Search terms included breast-feeding, lactation, nursing, and medications, as well as specific drug names. Data Synthesis: Concerns regarding medication use during breast-feeding have caused mothers to either discontinue nursing or not take necessary medications. Complete avoidance of medications or cessation of breast-feeding is often unnecessary. Although there are drugs that can be harmful to nursing infants, breast milk concentrations of most drugs are insufficient to cause any harm. Conclusions: Having objective and reliable information on medications enables pharmacists, pharmacy technicians, healthcare providers, and mothers to make educated decisions regarding drug therapy and breast-feeding.
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Affiliation(s)
- Frank J Nice
- FRANK J NICE MS MPA DPA CPHP, Assistant Director, Clinical Neurosciences Program (CNP), National Institutes of Health (NIH), Bethesda, MD
| | - Deborah DeEugenio
- DEBORAH DeEUGENIO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Assistant Professor, School of Pharmacy, Temple University, Philadelphia, PA; Clinical Pharmacist, Jefferson Antithrombotics Therapy Service, Jefferson Heart Institute, Philadelphia
| | - Traci A DiMino
- TRACI A DiMINO PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Adverse Event Specialist, Global Safety Surveillance & Epidemiology, Wyeth, Collegeville, PA
| | - Ingrid C Freeny
- INGRID C FREENY PharmD, at time of writing, Pharmacy Student (USP), CNP, NIH; now, Medical Student, Drexel University College of Medicine, Philadelphia
| | - Marissa B Rovnack
- MARISSA B ROVNACK PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Clinical Staff Pharmacist, Lehigh Valley Hospital and Health Network, Allentown, PA
| | - Joseph S Gromelski
- JOSEPH S GROMELSKI PharmD, at time of writing, Pharmacy Student (Wilkes University), CNP, NIH; now, Pharmacist, Walmart, Baltimore, MD; Law Student, University of Maryland, Baltimore
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187
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Levy RA, de Jesús GR, de Jesús NR, Klumb EM. Critical review of the current recommendations for the treatment of systemic inflammatory rheumatic diseases during pregnancy and lactation. Autoimmun Rev 2016; 15:955-63. [PMID: 27490204 DOI: 10.1016/j.autrev.2016.07.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 07/07/2016] [Indexed: 02/08/2023]
Abstract
The crucial issue for a better pregnancy outcome in women with autoimmune rheumatic diseases is appropriate planning, with counseling of the ideal timing and treatment adaptation. Drugs used to treat rheumatic diseases may interfere with fertility or increase the risk of miscarriages and congenital abnormalities. MTX use post-conception is clearly linked to abortions as well as major birth defects, so it should be stopped 3months before conception. Leflunomide causes abnormalities in animals even in low doses. Although in humans, it does not seem to be as harmful as MTX, when pregnancy is detected in a patient on leflunomide, cholestyramine is given for washout. Sulfasalazine can be used safely and is an option for those patients who were on MTX or leflunomide. Azathioprine is generally the immunosuppressive of choice in many high-risk pregnancy centers because of the safety profile and its steroid-sparing property. Cyclosporine and tacrolimus can also be used as steroid-sparing agents, but experience is smaller. Although prednisone and prednisolone are inactivated in the placenta, we try to limit the dose to the minimal effective one, to prevent side effects. Antimalarials have been broadly studied and are safe during pregnancy and breastfeeding. Among biologic disease modifying anti-rheumatic agents (bDMARD), the anti-TNFs that have been used for longer are the ones with greater experience. The large monoclonal antibodies do not cross the placenta in the first trimester, and after conception, the decision to continue medication should be taken individually. The experience is larger in women with inflammatory bowel diseases, where anti-TNF is generally maintained at least until 30weeks to reduce fetal exposure. Live vaccines should not be administrated to the infant in the first 6months of life. Pregnancy data for rituximab, abatacept, anakinra, tocilizumab, ustekinumab, belimumab, and tofacitinib are limited and their use in pregnancy cannot currently be recommended.
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Affiliation(s)
- Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Guilherme R de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Obstetrics, Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nilson R de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro M Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Pós-graduação em Ciências Médicas (PGCM), Faculdade de Ciências, Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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188
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Shenassa ED, Wen X, Braid S. Exposure to Tobacco Metabolites via Breast Milk and Infant Weight Gain: A Population-Based Study. J Hum Lact 2016; 32:462-71. [PMID: 26644421 DOI: 10.1177/0890334415619154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although the immutable benefits of breastfeeding are well documented, information on the potential consequences of exposure to tobacco metabolites specifically via breastfeeding is sparse. OBJECTIVE The aim was to conduct the first study of the association between exposure to tobacco metabolites specifically through breastfeeding and infant weight gain. METHODS We used historical data from the US Collaborative Perinatal Project. Mothers were classified as nonsmokers, light smokers (1-19 cigarettes/day), and heavy (20+ cigarettes/day) smokers. In-hospital feeding type was observed during a nursery stay after delivery. We conducted stratified analyses among average-for-gestational-age (AGA; N = 23 571) and small-for-gestational-age (SGA; N = 2552) infants. We isolated the effect of exposure to tobacco metabolites specifically through breastfeeding. RESULTS Overall, maternal smoking was associated with change in weight-for-length z-score in a dose-response manner. Change in weight z-score was most pronounced among SGA infants of heavy smokers (breastfed: 0.53; 95% confidence interval [CI], 0.12-0.94; formula fed: 0.17; 95% CI, 0.03-0.30). Exposure to tobacco metabolites specifically through breastfeeding was not associated with additional weight gain among AGA infants. Among the much smaller sample of SGA infants, exposure specifically through breastfeeding was associated with marginally significant additional weight gain (0.46; 95% CI, 0.00-0.91) among infants of heavy smokers. CONCLUSION Our findings are in accord with recommendations by health agencies for smokers to breastfeed. However, SGA infants exposed to tobacco metabolites via breastfeeding by heavy smokers appear to gain weight more rapidly than other infants. Practical implications of our findings are discussed.
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Affiliation(s)
- Edmond D Shenassa
- Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, MD, USA Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA Department of Epidemiology, School of Medicine, University of Maryland, Baltimore, MD, USA Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Susan Braid
- Department of Family and Community Health, University of Maryland, Baltimore, MD, USA
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189
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Smathers AB, Collins S, Hewer I. Perianesthetic Considerations for the Breastfeeding Mother. J Perianesth Nurs 2016; 31:317-29. [DOI: 10.1016/j.jopan.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/22/2014] [Accepted: 09/06/2014] [Indexed: 11/26/2022]
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190
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Laliberte B, Reed BN, Ather A, Devabhakthuni S, Watson K, Lardieri AB, Baker-Smith CM. Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy. Pharmacotherapy 2016; 36:955-70. [DOI: 10.1002/phar.1795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Benjamin Laliberte
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Brent N. Reed
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Ayesha Ather
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Sandeep Devabhakthuni
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Kristin Watson
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Allison B. Lardieri
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
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191
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Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, Johnson RH, Kusne S, Lisse J, MacDonald JD, Meyerson SL, Raksin PB, Siever J, Stevens DA, Sunenshine R, Theodore N. 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis 2016; 63:e112-46. [PMID: 27470238 DOI: 10.1093/cid/ciw360] [Citation(s) in RCA: 319] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.
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Affiliation(s)
| | - Neil M Ampel
- Division of Infectious Diseases, University of Arizona, Tucson
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Antonino Catanzaro
- Division of Pulmonary and Critical Care, University of California, San Diego
| | - Francesca Geertsma
- Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California
| | | | - Royce H Johnson
- David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California
| | - Shimon Kusne
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey Lisse
- Department of Rheumatology, University of Arizona, Tucson
| | - Joel D MacDonald
- Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City
| | - Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine
| | - Patricia B Raksin
- Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | | | - David A Stevens
- Division of Infectious Diseases, Stanford University School of Medicine, California
| | - Rebecca Sunenshine
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention Maricopa County Department of Public Health
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
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192
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Motta M, Tincani A, Lojacono A, Faden D, Gorla R, Airò P, Neri F, Gasparoni A, Ciardelli L, de Silvestri A, Marconi M, Chirico G. Neonatal outcome in patients with rheumatic disease. Lupus 2016; 13:718-23. [PMID: 15485111 DOI: 10.1191/0961203403lu2002oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rheumatic autoimmune diseases have a higher prevalence in women, particularly during their childbearing age. Due to improved management, an increasing number of patients plan and carry out one or more pregnancies. Therefore, a growing interest is being paid to the possible consequences of maternal disease and associated treatment on the fetus and newborn infant. If maternal disease is characterized by the presence of IgG isotype autoantibodies, these can cross the placenta with possible antibody-mediated damage to the fetus. This is typically the case of the so called neonatal lupus erythematosus (NLE); a similar mechanism has been shown in infants of patients with immune thrombocytopenic purpura (ITP) and, less frequently, in those from mothers with antiphospholipid syndrome (APS). Indeed, this last condition is often responsible for placental, rather than neonatal, pathology. In addition, immunosuppressive and other drugs administered to the mothers during pregnancy and lactation might affect the fetal and neonatal immune system development. Finally, mothers disease and/or treatment could be related to neuropsychological alteration reported in some of their children.
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Affiliation(s)
- M Motta
- Neonatology and Neonatal Intensive Care, Spedali Civili, Brescia, Italy.
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Abstract
This article reviews the current pharmacotherapy options available for the treatment of patients with substance use disorders. In the United States there are medications available to treat tobacco use disorders (nicotine replacement, bupropion, and varenicline), alcohol use disorders (naltrexone and acamprosate), and opioid use disorders (methadone and buprenorphine). These medications are likely underused and physicians should more readily prescribe for eligible patients.
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Affiliation(s)
- Jared Wilson Klein
- Division of General Internal Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA.
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194
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Biggs HM, Behravesh CB, Bradley KK, Dahlgren FS, Drexler NA, Dumler JS, Folk SM, Kato CY, Lash RR, Levin ML, Massung RF, Nadelman RB, Nicholson WL, Paddock CD, Pritt BS, Traeger MS. Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis - United States. MMWR Recomm Rep 2016; 65:1-44. [PMID: 27172113 DOI: 10.15585/mmwr.rr6502a1] [Citation(s) in RCA: 303] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Tickborne rickettsial diseases continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low-cost, effective antibacterial therapy. Recognition early in the clinical course is critical because this is the period when antibacterial therapy is most effective. Early signs and symptoms of these illnesses are nonspecific or mimic other illnesses, which can make diagnosis challenging. Previously undescribed tickborne rickettsial diseases continue to be recognized, and since 2004, three additional agents have been described as causes of human disease in the United States: Rickettsia parkeri, Ehrlichia muris-like agent, and Rickettsia species 364D. This report updates the 2006 CDC recommendations on the diagnosis and management of tickborne rickettsial diseases in the United States and includes information on the practical aspects of epidemiology, clinical assessment, treatment, laboratory diagnosis, and prevention of tickborne rickettsial diseases. The CDC Rickettsial Zoonoses Branch, in consultation with external clinical and academic specialists and public health professionals, developed this report to assist health care providers and public health professionals to 1) recognize key epidemiologic features and clinical manifestations of tickborne rickettsial diseases, 2) recognize that doxycycline is the treatment of choice for suspected tickborne rickettsial diseases in adults and children, 3) understand that early empiric antibacterial therapy can prevent severe disease and death, 4) request the appropriate confirmatory diagnostic tests and understand their usefulness and limitations, and 5) report probable and confirmed cases of tickborne rickettsial diseases to public health authorities.
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Affiliation(s)
- Holly M Biggs
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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195
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Affiliation(s)
- Yuko Shimizu
- Department of Neurology; Tokyo Women's Medical University School of Medicine; Tokyo Japan
| | - Kazuo Kitagawa
- Department of Neurology; Tokyo Women's Medical University School of Medicine; Tokyo Japan
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196
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Reggia R, Bazzani C, Andreoli L, Motta M, Lojacono A, Zatti S, Ramazzotto F, Nuzzo M, Tincani A. The Efficacy and Safety of Cyclosporin A in Pregnant Patients with Systemic Autoimmune Diseases. Am J Reprod Immunol 2016; 75:654-60. [DOI: 10.1111/aji.12514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/23/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Rossella Reggia
- Rheumatology and Clinical Immunology; Spedali Civili and University of Brescia; Brescia Italy
| | - Chiara Bazzani
- Rheumatology and Clinical Immunology; Spedali Civili and University of Brescia; Brescia Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology; Spedali Civili and University of Brescia; Brescia Italy
| | - Mario Motta
- Neonatology and Neonatal Intensive Care Unit; Spedali Civili and University of Brescia; Brescia Italy
| | - Andrea Lojacono
- Obstetrics and Gynecology; Spedali Civili and University of Brescia; Brescia Italy
| | - Sonia Zatti
- Obstetrics and Gynecology; Spedali Civili and University of Brescia; Brescia Italy
| | - Francesca Ramazzotto
- Obstetrics and Gynecology; Spedali Civili and University of Brescia; Brescia Italy
| | - Monica Nuzzo
- Functional Rieducation; San Rocco Clinic; Brescia Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology; Spedali Civili and University of Brescia; Brescia Italy
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197
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Haase B, Taylor SN, Mauldin J, Johnson TS, Wagner CL. Domperidone for Treatment of Low Milk Supply in Breast Pump-Dependent Mothers of Hospitalized Premature Infants: A Clinical Protocol. J Hum Lact 2016; 32:373-81. [PMID: 26905341 DOI: 10.1177/0890334416630539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/06/2016] [Indexed: 12/30/2022]
Abstract
Mothers of hospitalized premature infants who choose to provide breast milk are at increased risk of an inadequate breast milk supply. When nonpharmacologic interventions to increase milk supply fail, clinicians are faced with limited options. There is no current evidence to support the use of herbal galactogogues in this population and a black box warning for metoclopramide for potential serious side effects. Thus, domperidone was the only known, effective option for treatment of low milk supply in this population. With a thorough review of the literature on domperidone and coordination with the obstetrical, neonatal, lactation, and pharmacology teams, a domperidone treatment protocol for mothers of hospitalized premature infants with insufficient milk supply was developed at our institution and is presented in this article. A comprehensive understanding of domperidone for use as a galactogogue with a standard treatment protocol will facilitate safer prescribing practices and minimize potential adverse reactions in mothers and their hospitalized premature infants.
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Affiliation(s)
- Barbara Haase
- Department of Women and Children's Services, Medical University of South Carolina, Charleston, SC, USA
| | - Sarah N Taylor
- Division of Neonatology, Department of Pediatrics Medical University of South Carolina, Charleston, SC, USA
| | - Jill Mauldin
- Maternal Fetal Medicine and Medical Director of Women's Care Services, Medical University of South Carolina, Charleston, SC
| | - Teresa S Johnson
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Carol L Wagner
- Division of Neonatology, Department of Pediatrics Medical University of South Carolina, Charleston, SC, USA
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198
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Chomchai C, Chomchai S, Kitsommart R. Transfer of Methamphetamine (MA) into Breast Milk and Urine of Postpartum Women who Smoked MA Tablets during Pregnancy: Implications for Initiation of Breastfeeding. J Hum Lact 2016; 32:333-9. [PMID: 26452730 DOI: 10.1177/0890334415610080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/09/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Methamphetamine (MA) use by pregnant women remains a growing problem in South East Asia. After delivery, a negative maternal urine MA assay is assumed to reflect the absence of MA in breast milk and marks breastfeeding initiation. To date, no data exist that describe the relationship between the peripartum and postpartum transfer of MA into breast milk and its urinary excretion in women, following recreational use by smoking. OBJECTIVE This study aimed to determine the pharmacokinetic of smoked MA in breast milk and its relationship to urinary MA excretion in postpartum women who tested positive for MA before delivery. METHODS Timed urine and breast milk samples of 33 women who had positive urine drug screens for MA prior to delivery were analyzed for MA using Acquity Ultra Performance Liquid Chromatography (Waters, Milford, Massachusetts, USA) with the ACQUITY UPLC Photodiode Array Detector (Waters). Those participants with 4 or more timed breast milk samples were included for pharmacokinetic calculation using log-linear trapezoidal rule. RESULTS Pharmacokinetic data from 2 women were analyzed. The half-life values for MA in the breast milk were 11.3 and 40.3 hours. The absolute infant doses were 21.3 and 51.7 µg/kg/day. Methamphetamine disappears from breast milk approximately 1 day before the maternal urine MA becomes negative. CONCLUSION Smoked MA shows a similar breast milk pharmacokinetic pattern to previously reported intravenous MA. Breastfeeding can be safely initiated in mothers whose urine MA screen has turned negative for ≥ 24 hours. However, concurrent maternal substance use treatment and screening is necessary for continued promotion of lactation.
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Affiliation(s)
- Chulathida Chomchai
- Mahidol University International College, Mahidol University, Nakhonpathom, Thailand
| | - Summon Chomchai
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Yaksh A, van der Does LJ, Lanters EA, de Groot NM. Pharmacological Therapy of Tachyarrhythmias During Pregnancy. Arrhythm Electrophysiol Rev 2016; 5:41-4. [PMID: 27408722 PMCID: PMC4940191 DOI: 10.15420/aer.2016.1.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/15/2016] [Indexed: 11/04/2022] Open
Abstract
Tachyarrhythmias are the most frequently observed cardiac complications during pregnancy. The majority of these maternal and foetal arrhythmias are supraventricular tachyarrhythmias; ventricular tachyarrhythmias are rare. The use of anti-arrhythmic drugs (AADs) during pregnancy is challenging due to potential foetal teratogenic effects. Maintaining stable and effective therapeutic maternal drug levels is difficult due to haemodynamic and metabolic alterations. Pharmacological treatment of tachyarrhythmias is indicated in case of maternal haemodynamic instability or hydrops fetalis. Evidenc e regarding the efficacy and safety of AAD therapy during pregnancy is scarce and the choice of AAD should be based on individual risk assessments for both mother and foetus. This review outlines the current knowledge on the development of tachyarrhythmias during pregnancy, the indications for and considerations of pharmacological treatment and its potential side-effects.
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Affiliation(s)
- Ameeta Yaksh
- Erasmus Medical Center, Rotterdam, The Netherlands
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Wan J, Imadojemu S, Werth VP. Management of rheumatic and autoimmune blistering disease in pregnancy and postpartum. Clin Dermatol 2016; 34:344-52. [DOI: 10.1016/j.clindermatol.2016.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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