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Pijpers EL, Kreijkamp-Kaspers S, McGuire TM, Deckx L, Brodribb W, van Driel ML. Women's questions about medicines in pregnancy - An analysis of calls to an Australian national medicines call centre. Aust N Z J Obstet Gynaecol 2016; 57:334-341. [DOI: 10.1111/ajo.12531] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Eva L. Pijpers
- Faculty of Medicine; Rijksuniversiteit Groningen; Groningen The Netherlands
| | - Sanne Kreijkamp-Kaspers
- Discipline of General Practice; School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Treasure M. McGuire
- Mater Pharmacy Services; Mater Health Services; Raymond Terrace South Brisbane Queensland Australia
- School of Pharmacy; Pharmacy Australia Centre of Excellence; The University of Queensland; Brisbane Queensland Australia
| | - Laura Deckx
- Discipline of General Practice; School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Wendy Brodribb
- Discipline of General Practice; School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Mieke L. van Driel
- Discipline of General Practice; School of Medicine; The University of Queensland; Brisbane Queensland Australia
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252
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Fisher BG, Thankamony A, Hughes IA, Ong KK, Dunger DB, Acerini CL. Prenatal paracetamol exposure is associated with shorter anogenital distance in male infants. Hum Reprod 2016; 31:2642-2650. [PMID: 27609981 PMCID: PMC5088633 DOI: 10.1093/humrep/dew196] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/18/2016] [Accepted: 07/15/2016] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the relationship between maternal paracetamol intake during the masculinisation programming window (MPW, 8-14 weeks of gestation) and male infant anogenital distance (AGD), a biomarker for androgen action during the MPW? SUMMARY ANSWER Intrauterine paracetamol exposure during 8-14 weeks of gestation is associated with shorter AGD from birth to 24 months of age. WHAT IS ALREADY KNOWN The increasing prevalence of male reproductive disorders may reflect environmental influences on foetal testicular development during the MPW. Animal and human xenograft studies have demonstrated that paracetamol reduces foetal testicular testosterone production, consistent with reported epidemiological associations between prenatal paracetamol exposure and cryptorchidism. STUDY DESIGN, SIZE, DURATION Prospective cohort study (Cambridge Baby Growth Study), with recruitment of pregnant women at ~12 post-menstrual weeks of gestation from a single UK maternity unit between 2001 and 2009, and 24 months of infant follow-up. Of 2229 recruited women, 1640 continued with the infancy study after delivery, of whom 676 delivered male infants and completed a medicine consumption questionnaire. PARTICIPANTS/MATERIALS, SETTING, METHOD Mothers self-reported medicine consumption during pregnancy by a questionnaire administered during the perinatal period. Infant AGD (measured from 2006 onwards), penile length and testicular descent were assessed at 0, 3, 12, 18 and 24 months of age, and age-specific Z scores were calculated. Associations between paracetamol intake during three gestational periods (<8 weeks, 8-14 weeks and >14 weeks) and these outcomes were tested by linear mixed models. Two hundred and twenty-five (33%) of six hundred and eighty-one male infants were exposed to paracetamol during pregnancy, of whom sixty-eight were reported to be exposed during 8-14 weeks. AGD measurements were available for 434 male infants. MAIN RESULTS AND THE ROLE OF CHANCE Paracetamol exposure during 8-14 weeks of gestation, but not any other period, was associated with shorter AGD (by 0.27 SD, 95% CI 0.06-0.48, P = 0.014) from birth to 24 months of age. This reduction was independent of body size. Paracetamol exposure was not related to penile length or testicular descent. LIMITATIONS, REASONS FOR CAUTION Confounding by other drugs or endocrine-disrupting chemicals cannot be discounted. The cohort was not fully representative of pregnant women in the UK, particularly in terms of maternal ethnicity and smoking prevalence. There is likely to have been misclassification of paracetamol exposure due to recall error. WIDER IMPLICATIONS OF THE FINDINGS Our observational findings support experimental evidence that intrauterine paracetamol exposure during the MPW may adversely affect male reproductive development. STUDY FUNDING/COMPETING INTERESTS This work was supported by a European Union Framework V programme, the World Cancer Research Fund International, the Medical Research Council (UK), the Newlife Foundation for Disabled Children, the Evelyn Trust, the Mothercare Group Foundation, Mead Johnson Nutrition, and the National Institute for Health Research Cambridge Comprehensive Biomedical Research Centre. The authors declare no conflict of interest.
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Affiliation(s)
- B G Fisher
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - A Thankamony
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - I A Hughes
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - K K Ong
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.,MRC Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - D B Dunger
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - C L Acerini
- Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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253
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Ilekis JV, Tsilou E, Fisher S, Abrahams VM, Soares MJ, Cross JC, Zamudio S, Illsley NP, Myatt L, Colvis C, Costantine MM, Haas DM, Sadovsky Y, Weiner C, Rytting E, Bidwell G. Placental origins of adverse pregnancy outcomes: potential molecular targets: an Executive Workshop Summary of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Am J Obstet Gynecol 2016; 215:S1-S46. [PMID: 26972897 DOI: 10.1016/j.ajog.2016.03.001] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/11/2016] [Accepted: 03/01/2016] [Indexed: 12/26/2022]
Abstract
Although much progress is being made in understanding the molecular pathways in the placenta that are involved in the pathophysiology of pregnancy-related disorders, a significant gap exists in the utilization of this information for the development of new drug therapies to improve pregnancy outcome. On March 5-6, 2015, the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health sponsored a 2-day workshop titled Placental Origins of Adverse Pregnancy Outcomes: Potential Molecular Targets to begin to address this gap. Particular emphasis was given to the identification of important molecular pathways that could serve as drug targets and the advantages and disadvantages of targeting these particular pathways. This article is a summary of the proceedings of that workshop. A broad number of topics were covered that ranged from basic placental biology to clinical trials. This included research in the basic biology of placentation, such as trophoblast migration and spiral artery remodeling, and trophoblast sensing and response to infectious and noninfectious agents. Research findings in these areas will be critical for the formulation of the development of future treatments and the development of therapies for the prevention of a number of pregnancy disorders of placental origin that include preeclampsia, fetal growth restriction, and uterine inflammation. Research was also presented that summarized ongoing clinical efforts in the United States and in Europe that has tested novel interventions for preeclampsia and fetal growth restriction, including agents such as oral arginine supplementation, sildenafil, pravastatin, gene therapy with virally delivered vascular endothelial growth factor, and oxygen supplementation therapy. Strategies were also proposed to improve fetal growth by the enhancement of nutrient transport to the fetus by modulation of their placental transporters and the targeting of placental mitochondrial dysfunction and oxidative stress to improve placental health. The roles of microRNAs and placental-derived exosomes, as well as messenger RNAs, were also discussed in the context of their use for diagnostics and as drug targets. The workshop discussed the aspect of safety and pharmacokinetic profiles of potential existing and new therapeutics that will need to be determined, especially in the context of the unique pharmacokinetic properties of pregnancy and the hurdles and pitfalls of the translation of research findings into practice. The workshop also discussed novel methods of drug delivery and targeting during pregnancy with the use of macromolecular carriers, such as nanoparticles and biopolymers, to minimize placental drug transfer and hence fetal drug exposure. In closing, a major theme that developed from the workshop was that the scientific community must change their thinking of the pregnant woman and her fetus as a vulnerable patient population for which drug development should be avoided, but rather be thought of as a deprived population in need of more effective therapeutic interventions.
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Affiliation(s)
- John V Ilekis
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Department of Health and Human Services, Bethesda, MD.
| | - Ekaterini Tsilou
- Obstetric and Pediatric Pharmacology and Therapeutics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Department of Health and Human Services, Bethesda, MD.
| | - Susan Fisher
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Vikki M Abrahams
- Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine; New Haven, CT
| | - Michael J Soares
- Institute of Reproductive Health and Regenerative Medicine and Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS
| | - James C Cross
- Comparative Biology and Experimental Medicine, University of Calgary Health Sciences Centre, Calgary, Alberta, Canada
| | - Stacy Zamudio
- Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, NJ
| | - Nicholas P Illsley
- Department of Obstetrics and Gynecology, Hackensack University Medical Center, Hackensack, NJ
| | - Leslie Myatt
- Center for Pregnancy and Newborn Research, University of Texas Health Science Center, San Antonio, TX
| | - Christine Colvis
- Therapeutics Discovery Program, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD
| | - Maged M Costantine
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - David M Haas
- Department of Obstetrics and Gynecology Indiana University, Indianapolis, IN
| | | | - Carl Weiner
- University of Kansas Medical Center, Kansas City, KS
| | - Erik Rytting
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Gene Bidwell
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS
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254
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Women's beliefs about medication use during their pregnancy: a UK perspective. Int J Clin Pharm 2016; 38:968-76. [PMID: 27241342 PMCID: PMC4929153 DOI: 10.1007/s11096-016-0322-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 05/13/2016] [Indexed: 11/24/2022]
Abstract
Background Previous research has examined the number and extent of medicines taking in pregnant women but not their beliefs and risk perception surrounding their use. Objective To describe beliefs and risk perception associated with medicines use for the treatment of common acute conditions among UK women and explore whether this is related to actual medicines use. Settings Cross-sectional, web-based study in the UK. Methods Pregnant women and mothers within 1 year of giving birth were invited to participate in an online cross-sectional questionnaire-based study via a pregnancy website in the UK. Anonymous data were collected from women regarding their use of medicines (both over-the-counter and prescribed) and their beliefs regarding medicines use during pregnancy. Main outcome measures Pregnant women’s beliefs about medicines and their relation to pharmacological treatment of acute conditions in pregnancy. Results Pharmacological treatment of conditions in pregnancy ranged from 65.4 % for urinary tract infections (UTIs) to 1.1 % for sleeping problems. Almost three out of ten women avoided using some medications during pregnancy. For heartburn and UTIs, women who did not treat the condition viewed medicines in general as being overused, more harmful and less beneficial, than those who treated the condition. In general, UK pregnant women perceived medicines to be beneficial and slightly overused. Conclusions Women’s beliefs about medications impact on treatment of specific conditions in pregnancy such as heartburn and UTIs. Healthcare professionals should explore patient’s beliefs regarding medication at the first maternity care visit to promote appropriate medication use in pregnancy.
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255
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Bakkebø T, Widnes SF, Aamlid SS, Schjøtt J. Physicians’ Perception of Teratogenic Risk and Confidence in Prescribing Drugs in Pregnancy—Influence of Norwegian Drug Information Centers. Clin Ther 2016; 38:1102-8. [DOI: 10.1016/j.clinthera.2016.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/29/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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256
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Smedberg J, Bråthen M, Waka MS, Jacobsen AF, Gjerdalen G, Nordeng H. Medication use and drug-related problems among women at maternity wards—a cross-sectional study from two Norwegian hospitals. Eur J Clin Pharmacol 2016; 72:849-57. [DOI: 10.1007/s00228-016-2042-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/09/2016] [Indexed: 12/30/2022]
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Corbel A, Baud D, Chaouch A, Beney J, Csajka C, Panchaud A. Utility of an Algorithm to Increase the Accuracy of Medication History in an Obstetrical Setting. PLoS One 2016; 11:e0151205. [PMID: 26999743 PMCID: PMC4801413 DOI: 10.1371/journal.pone.0151205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/23/2016] [Indexed: 11/24/2022] Open
Abstract
Background In an obstetrical setting, inaccurate medication histories at hospital admission may result in failure to identify potentially harmful treatments for patients and/or their fetus(es). Methods This prospective study was conducted to assess average concordance rates between (1) a medication list obtained with a one-page structured medication history algorithm developed for the obstetrical setting and (2) the medication list reported in medical records and obtained by open-ended questions based on standard procedures. Both lists were converted into concordance rate using a best possible medication history approach as the reference (information obtained by patients, prescribers and community pharmacists’ interviews). Results The algorithm-based method obtained a higher average concordance rate than the standard method, with respectively 90.2% [CI95% 85.8–94.3] versus 24.6% [CI95%15.3–34.4] concordance rates (p<0.01). Conclusion Our algorithm-based method strongly enhanced the accuracy of the medication history in our obstetric population, without using substantial resources. Its implementation is an effective first step to the medication reconciliation process, which has been recognized as a very important component of patients’ drug safety.
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Affiliation(s)
- Aline Corbel
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
| | - David Baud
- Department of Gynecology and Obstetrics, University Hospital of Lausanne, Lausanne, Switzerland
| | - Aziz Chaouch
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Johnny Beney
- Division of Pharmacy, Central Institute of the Valais Hospitals, Sion, Switzerland
| | - Chantal Csajka
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
- Division of Clinical Pharmacology, University Hospital of Lausanne, Lausanne, Switzerland
- * E-mail:
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258
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Safety classification of herbal medicines used in pregnancy in a multinational study. Altern Ther Health Med 2016; 16:102. [PMID: 26980526 PMCID: PMC4793610 DOI: 10.1186/s12906-016-1079-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 03/09/2016] [Indexed: 01/25/2023]
Abstract
Background The use of herbal medicines for health prevention and ailments is an increasing trend worldwide. Women in pregnancy are no exception; the reported prevalence of herbal medicine use in pregnancy ranges from 1 to 60 %. Despite a common perception of safety, herbal medicines may have potent pharmacological actions, and historically, have been used for this reason. Methods A multinational, cross-sectional study on how women treat disease and pregnancy-related health ailments was conducted between October 2011 and February 2012 in Europe, North America, and Australia. This study’s primary aim was to evaluate and classify the herbal medicines used according to their safety in pregnancy and, secondly, to investigate risk factors associated with the use of contraindicated herbal medicines during pregnancy. Results In total, 29.3 % of the women (n = 2673) reported the use of herbal medicines in pregnancy; of which we were able to identify 126 specific herbal medicines used by 2379 women (89.0 %). Twenty seven out of 126 herbal medicines were classified as contraindicated in pregnancy, and were used by 476 women (20.0 %). Twenty-eight were classified as safe for use in pregnancy and used by the largest number of women (n = 1128, 47.4 %). The greatest number was classified as requiring caution in pregnancy; these sixty herbal medicines were used by 751 women (31.6 %). Maternal factors associated with the use of contraindicated herbal medicines in pregnancy were found to be working in the home, having a university education, not using folic acid, and consuming alcohol. Interestingly, the recommendation to take a contraindicated herbal medicine was three times more likely to be from a healthcare practitioner (HCP) than an informal source. Conclusion Based on the current literature the majority of women in this study used an herbal medicine that was classified as safe for use in pregnancy. Women who reported taking a contraindicated herb were more likely to have been recommended it use by an HCP rather than informal source(s), indicating an urgent need for more education among HCPs. The paucity of human studies on herbal medicines safety in pregnancy stands in stark contrast to the widespread use of these products among pregnant women. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1079-z) contains supplementary material, which is available to authorized users.
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Loubet P, Guerrisi C, Turbelin C, Blondel B, Launay O, Bardou M, Blanchon T, Bonmarin I, Goffinet F, Ancel PY, Colizza V, Hanslik T, Kernéis S. First nationwide web-based surveillance system for influenza-like illness in pregnant women: participation and representativeness of the French G-GrippeNet cohort. BMC Public Health 2016; 16:253. [PMID: 26969654 PMCID: PMC4788930 DOI: 10.1186/s12889-016-2899-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background Pregnancy is a risk factor for severe influenza resulting in increased risks of hospitalisation and death in mothers and their new-borns. Our objective was to assess the representativeness and participation of French women to a new web-based collaborative tool for data collection and monitoring of Influenza Like Illness (ILI) during pregnancy. Methods During the 2014/2015 influenza season, pregnant women living in metropolitan France were enrolled through a web platform (https://www.grippenet.fr/). Then throughout the season, participants were asked to report, on a weekly basis, if they had experienced symptoms of ILI. Representativeness was assessed by comparing the characteristics of participants to those of the French National Perinatal Survey. For each participant, the participation rate was the number of weekly questionnaires completed, divided by the length of follow-up (in weeks). Predictors of active participation (participation rate >15 %) were assessed by multivariate logistic regression. Results A total of 153 women were enrolled. Participants were older (mean age 34 years vs. 29 years) and more highly educated (high school level 89 % versus 52 %) than the general population of pregnant women in France, but the sample did not differ on pregnancy-related characteristics (parity, history of hospitalisation during a previous pregnancy). The median rate of participation was high (78 %, interquartile range: 34–96). Higher educational level and participation to a previous GrippeNet.fr season were associated with active participation. Conclusion Despite small sample size and lack of representativeness, the retention rate was high, suggesting that pregnant women are prone to adhere to a longitudinal follow-up of their health status via the Internet.
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Affiliation(s)
- Paul Loubet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.,Department of Infectious diseases, CIC Cochin-Pasteur, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Caroline Guerrisi
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Clément Turbelin
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Béatrice Blondel
- INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Odile Launay
- Department of Infectious diseases, CIC Cochin-Pasteur, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.,INSERM CIC 1417, Paris, France.,Inserm, F-CRIN, Innovative clinical research network in vaccinology (I-REIVAC), Paris, France
| | - Marc Bardou
- Clinical Investigation Center (CIC) INSERM 1432, Gynecology and Obstetrics CIC Network (GO-CIC) & Hepato-gastroenterology department, Dijon Hospital, Dijon, France
| | - Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Isabelle Bonmarin
- Department of Infectious Diseases, Institut de Veille Sanitaire (InVS), St Maurice, France
| | - François Goffinet
- INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.,Department of Obstetrics and Gynecology, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre-Yves Ancel
- INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
| | - Vittoria Colizza
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Thomas Hanslik
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France
| | - Solen Kernéis
- Department of Infectious diseases, CIC Cochin-Pasteur, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. .,INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France. .,INSERM CIC 1417, Paris, France.
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Bérard A, Wisner KL, Hultzsch S, Chambers C. Field studies versus database studies on the risks and benefits of medication use during pregnancy: Distinct pieces of the same puzzle. Reprod Toxicol 2016; 60:123-8. [PMID: 26876485 DOI: 10.1016/j.reprotox.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/10/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
Over the past two decades, findings on medication use during pregnancy have been accumulating from observational data. Generally, field studies with prospective recruitment of subjects have better outcome ascertainment, and more control on the longitudinal collection of data, but have lower sample sizes and thus they often lack statistical power to detect increased risks for rare events such as major congenital malformations. In addition, given the rarity of specific drug exposures in a population, even relatively common outcomes, such as low birth weight, may become rare in combination with the specific exposure. On the other hand, administrative databases usually provide larger samples and thus increased statistical power, decrease the probability of selection and recall bias, but often have missing data on potential confounders. Hence, debate amongst researchers, regulators and public health officials has been ongoing with regard to the most appropriate study populations for perinatal epidemiologic research. With this commentary, we aim to highlight the importance of both study populations, which can make complementary and crucial contributions to the iterative determination of causality as well as discuss basic epidemiologic principles that need to be applied in the field of perinatal pharmacoepidemiology for the purpose of causality assessment. This is relevant at present given that the United States Food and Drug Administration (US FDA) has modified their medication label requirements, especially given the international importance of these modifications.
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Affiliation(s)
- Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada; Research Centre, CHU Sainte-Justine, Montreal, QC, Canada.
| | - Katherine L Wisner
- Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stefanie Hultzsch
- Pharmakovigilanz-und Beratungszentrum für Embryonaltoxikologie, Berlin Institute for Clinical, Teratology and Drug Risk Assessment in Pregnancy, Charité-Universitätsmedizin, Berlin, Germany
| | - Christina Chambers
- Department of Pediatrics, Division of Dysmorphology and Teratology, University of California San Diego, La Jolla, CA, USA
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261
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Heitmann K, Solheimsnes A, Havnen GC, Nordeng H, Holst L. Treatment of nausea and vomiting during pregnancy —a cross-sectional study among 712 Norwegian women. Eur J Clin Pharmacol 2016; 72:593-604. [DOI: 10.1007/s00228-016-2012-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/12/2016] [Indexed: 02/08/2023]
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262
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van der Zande ISE, van der Graaf R, Browne JL, van Delden JJM. Fair Inclusion of Pregnant Women in Clinical Research: A Systematic Review of Reported Reasons for Exclusion. RESEARCH ETHICS FORUM 2016. [DOI: 10.1007/978-3-319-26512-4_5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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263
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Hoeke H, Roeder S, Bertsche T, Borte M, von Bergen M, Wissenbach DK. Assessment of maternal drug intake by urinary bio monitoring during pregnancy and postpartally until the third perinatal year. Pharmacoepidemiol Drug Saf 2015; 25:431-7. [DOI: 10.1002/pds.3943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Henrike Hoeke
- Department of Pharmaceutical and Medicinal Chemistry; Institute of Pharmacy, University of Leipzig; Leipzig Germany
- Department of Metabolomics; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
| | - Stefan Roeder
- Department of Environmental Immunology; Helmholtz Centre for Environmental Research-UFZ; Leipzig Germany
| | - Thilo Bertsche
- Department of Clinical Pharmacy; Institute of Pharmacy, University of Leipzig; Leipzig Germany
- Drug Safety Center, University Hospital Leipzig and University of Leipzig; Leipzig Germany
| | - Michael Borte
- Children's Hospital, Municipal Hospital St. Georg Leipzig, affiliated to the University of Leipzig; Leipzig Germany
| | - Martin von Bergen
- Department of Metabolomics; Helmholtz Centre for Environmental Research -UFZ; Leipzig Germany
- Department of Biotechnology, Chemistry and Environmental Engineering; Aalborg University; Aalborg Denmark
| | - Dirk K. Wissenbach
- Children's Hospital, Municipal Hospital St. Georg Leipzig, affiliated to the University of Leipzig; Leipzig Germany
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264
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Treatment of nausea in pregnancy: a cross-sectional multinational web-based study of pregnant women and new mothers. BMC Pregnancy Childbirth 2015; 15:321. [PMID: 26628289 PMCID: PMC4667480 DOI: 10.1186/s12884-015-0746-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The factors related to the treatment of nausea during pregnancy have not yet been investigated in several countries simultaneously. The present study aimed to describe differences in self-reported nausea during pregnancy and the patterns of use for both conventional and herbal medicines across countries. The factors related to nausea and its treatment and the relationships between different self-reported co-morbidities and nausea were also investigated. METHODS This cross-sectional study used data collected by a web-based questionnaire distributed between October 2011 and February 2012 in several countries within five regions: Western, Northern, and Eastern Europe, North America, and Australia. Women who were pregnant or had a child less than one year old were eligible to participate. RESULTS A total of 9113 women were included in the study, whereof 6701 (73.5%) had experienced nausea during pregnancy. Among respondents with nausea, conventional medicines were used by 1201 (17.9%) women and herbal medicines by 556 (8.3%) women. The extent of self-reported nausea and its treatment varied by country. Education, working status, and folic acid use were significantly associated with the use of conventional medicines against nausea. Respondents who had nausea also had a high burden of co-morbidity. CONCLUSION The prevalence of nausea was high across all participating countries but its treatment varied, possibly due to cultural differences and differences in attitudes towards medicines. A high degree of co-morbidity was found among respondents with nausea.
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265
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Hypothyroidism and medication adherence in pregnancy – A cross-sectional, multinational web-based study. Reprod Toxicol 2015. [DOI: 10.1016/j.reprotox.2015.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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266
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Abstract
The use of prescribed and over-the-counter medications in pregnancy is on the rise. Many women become pregnant at an older age and with preexisting medical conditions that require pharmacotherapy. In addition, pregnancy is associated with profound changes in the physiology of virtually every organ in the body, which affect medications' pharmacokinetics and pharmacodynamics. Despite all of these, pregnant women are still considered therapeutic orphans, as the majority of current therapeutics were never studied in pregnancy. The goals of this review are to synthesize the available information regarding the epidemiology of medications use and the state of drug research in pregnancy, in an effort to highlight the need for pharmacologic research in pregnancy.
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Affiliation(s)
- Martina Ayad
- Fellow, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX
| | - Maged M. Costantine
- Associate Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX
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267
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Wyszynski DF, Shields KE. Frequency and type of medications and vaccines used during pregnancy. Obstet Med 2015; 9:21-7. [PMID: 27512486 DOI: 10.1177/1753495x15604099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Providing safe pharmacotherapy for pregnant women is challenging. Nearly all pregnant women are prescribed or inadvertently receive medication during their pregnancy. We reviewed the scientific literature to identify the specific medications and vaccines that are most often used during pregnancy and described them by category and indication. Our interest was to update the research before the implementation of the recently released FDA labeling rule for pregnancy and lactation that eliminates the use of pregnancy categories in product labels. Our results confirm that most products taken during pregnancy are over-the-counter or in the former FDA pregnancy categories A or B. However, medications taken prior to pregnancy recognition (inadvertent exposures) and those prescribed for chronic illness such as allergies, depression, and pain are of concern. A better understanding of medication and vaccine utilization during pregnancy may help clinicians reduce inadvertent first trimester exposures and improve the safe and effective treatment of pregnant women.
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268
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Kassada DS, Miasso AI, Waidman MAP, Marcon SS. Prevalence and factors associated with drug use in pregnant women assisted in primary care. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015002770013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to identify the prevalence of drug use by pregnant women assisted in primary care; classifying the medications used according to the risk according to the Food and Drug Administration and grouping drugs used according to the Anatomical Therapeutic Classification. A cross-sectional analytical study was developed in Maringá, Paraná. Data were collected between January and July 2012 through semi-structured interviews in households. The sample comprised 394 pregnant women at different gestational ages. Results revealed that 94.67% of the pregnant women (2.03%) used at least one medication without medical prescription and the most used drugs were antianemics, followed by antiemetics and analgesics. Data showed a statistically significant relationship between the use of medicines and marital conditions, trimester of pregnancy, chronic disease, mental illness and orientation of professionals at the Basic Health Units about medicines. It is noteworthy that, given the complexity of the theme, health professionals, especially nurses, should approach the subject in the care of pregnant women.
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269
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de Fays L, Van Malderen K, De Smet K, Sawchik J, Verlinden V, Hamdani J, Dogné JM, Dan B. Use of paracetamol during pregnancy and child neurological development. Dev Med Child Neurol 2015; 57:718-24. [PMID: 25851072 DOI: 10.1111/dmcn.12745] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 12/13/2022]
Abstract
Paracetamol (acetaminophen) remains the first line for the treatment of pain and fever in pregnancy. Recently published epidemiological studies suggested a possible association between paracetamol exposure in utero and attention-deficit-hyperactivity disorder/hyperkinetic disorder (ADHD/HKD) or adverse development issues in children. However, the effects observed are in the weak to moderate range, and limitations in the studies' design prevent inference on a causal association with ADHD/HKD or child neurological development. In parallel, recent animal data showed that cognition and behaviour may be altered following exposure to therapeutic doses of paracetamol during early development. These effects may be mediated by interference of paracetamol with brain-derived neurotrophic factor, neurotransmitter systems (including serotonergic, dopaminergic, adrenergic, as well as the endogenous endocannabinoid systems), or cyclooxygenase-2. However, no firm conclusion can be made on the relevance of these observations to humans. We conclude that additional well-designed cohort studies are necessary to confirm or disprove the association. In the context of current knowledge, paracetamol is still to be considered safe in pregnancy and should remain the first-line treatment for pain and fever.
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Affiliation(s)
- Laurence de Fays
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Karen Van Malderen
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Karen De Smet
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Javier Sawchik
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Veerle Verlinden
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | - Jamila Hamdani
- Federal Agency for Medicines and Health Products (FAMHP), Brussels, Belgium
| | | | - Bernard Dan
- Laboratory of Neurophysiology and Biomechanics of Movement, ULB Neuroscience Institut, Université Libre de Bruxelles, Brussels, Belgium
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270
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Nash L, Dixon R, Eaton V, Grzeskowiak LE. Accuracy of information on medication use and adverse drug reactions recorded in pregnancy hand-held records. Aust N Z J Obstet Gynaecol 2015; 55:547-51. [PMID: 26122265 DOI: 10.1111/ajo.12371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pregnancy hand-held records (PHR) are a personally controlled health record utilised in the promotion of continuity of care across pregnancy by providing a single resource for the recording of pregnancy-related health information. AIMS To determine the accuracy of the PHR in relation to information on medications and adverse drug reactions (ADRs) and to examine the frequency and nature of any identified discrepancies. MATERIALS AND METHODS A 12-week prospective clinical audit of 300 women admitted to either the antenatal or postnatal ward at a tertiary-level maternity hospital. A detailed medication history was completed for each woman by a pharmacist, with women interviewed about medication use prior to and during their pregnancy as well as any ADRs. The medication history and PHR were compared to identify discrepancies. RESULTS Medication discrepancies were extremely common, with 254 (84.7%; 95% CI 80.6-88.8%) women having at least one or more medication-related discrepancy involving 686 (55%; 95% CI 52.2-57.8%) prescription and nonprescription medications. Most common reasons for prescription medication discrepancies included the medication details being incomplete (44%), missing (29%) or incorrect (17%). ADRs and allergy discrepancies were also common, identified among 59 (20%; 95% CI 15.5-24.5%) women. CONCLUSIONS The PHR is of low accuracy in relation to the recording of medications and ADRs. This warrants further research to examine the impact of these discrepancies on patient care and outcomes. The identification of strategies for improving the recording of information on medications and ADRs in the PHR is also required.
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Affiliation(s)
- Lauren Nash
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Rowena Dixon
- SA Pharmacy, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Vaughn Eaton
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.,SA Pharmacy, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Luke E Grzeskowiak
- SA Pharmacy, Flinders Medical Centre, Adelaide, South Australia, Australia.,The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
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271
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Dickinson JE. Nonprescription and complementary medication in obstetrics. Aust N Z J Obstet Gynaecol 2015; 55:199-200. [PMID: 26084193 DOI: 10.1111/ajo.12365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jan E Dickinson
- Australian and New Zealand Journal of Obstetrics and Gynaecology, School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
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272
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Lupattelli A, Spigset O, Björnsdóttir I, Hämeen-Anttila K, Mårdby AC, Panchaud A, Juraski RG, Rudolf G, Odalovic M, Drozd M, Twigg MJ, Juch H, Moretti ME, Kennedy D, Rieutord A, Zagorodnikova K, Passier A, Nordeng H. Patterns and factors associated with low adherence to psychotropic medications during pregnancy--a cross-sectional, multinational web-based study. Depress Anxiety 2015; 32:426-36. [PMID: 25703355 DOI: 10.1002/da.22352] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/15/2014] [Accepted: 12/17/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy. METHODS Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis. RESULTS On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence. CONCLUSIONS Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.
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Affiliation(s)
| | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and Lausanne, Geneva, Switzerland
| | | | - Gorazd Rudolf
- Clinical Institute of Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marina Odalovic
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Mariola Drozd
- Faculty of Pharmacy, Medical University of Lublin, Lublin, Poland
| | - Michael J Twigg
- School of Pharmacy, University of East Anglia, Norwich Research Park, UK
| | - Herbert Juch
- Research Unit Human Teratogens, Institute for Cell Biology, Histology and Embryology, Medical University of Graz, Graz, Austria
| | - Myla E Moretti
- The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women and University of NSW, Randwick, Australia
| | - Andre Rieutord
- APHP, GH HUPS, Hop Antoine Béclère, Service Pharmacie, Clamart France and Européenne de Formation pour les Pharmaciens, France
| | - Ksenia Zagorodnikova
- Northwest Medical Center for Drug Safety in Pregnancy & Lactation, Northwest State Medical University n.a.I.I.Mechnikov, St. Petersburg, Russia
| | - Anneke Passier
- Teratology Information Service (TIS), Netherlands Pharmacovigilance Centre Lareb, The Netherlands
| | - Hedvig Nordeng
- School of Pharmacy, University of Oslo, Oslo, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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273
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Petersen I, McCrea RL, Lupattelli A, Nordeng H. Women's perception of risks of adverse fetal pregnancy outcomes: a large-scale multinational survey. BMJ Open 2015; 5:e007390. [PMID: 26033946 PMCID: PMC4458601 DOI: 10.1136/bmjopen-2014-007390] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine pregnant women and new mothers' perception of risks in pregnancy. DESIGN, SETTINGS AND PARTICIPANTS This was a large-scale multinational survey including 9113 pregnant women and new mothers from 18 countries in Europe, North America and Australia. MAIN OUTCOMES Risk perception scores (0-10) for harmful effects to the fetus were derived for: (1) medicines (over-the-counter medicine and prescribed medicine), (2) food substances (eggs and blue veined cheese), (3) herbal substances (ginger and cranberries) (4) alcohol and tobacco, and (5) thalidomide. RESULTS Overall, 80% (6453/8131) of women perceived the risk of giving birth to a child with a birth defect to be ≤ 5 of 100 births. The women rated cranberries and ginger least harmful (mean risk perception scores 1.1 and 1.5 of 10, respectively) and antidepressants, alcohol, smoking and thalidomide as most harmful (7.6, 8.6, 9.2 and 9.4 out of 10, respectively). The perception varied with age, level of education, pregnancy status, profession and geographical region. Noticeably, 70% had not heard about thalidomide, but of those who had (2692/9113), the risk perception scores were 0.4-0.5 points lower in women below 25 years compared to women aged 26-30 years. CONCLUSIONS In general, women perceived the risks of giving birth to a child with birth defects low, but there were substantial disparities between women's perceived risks and the actual risks when it comes to over-the-counter agents against nausea and prescribed medication. The study revealed that few women knew of thalidomide, suggesting that the general awareness among women of the teratogenic effects of thalidomide is declining, but it has left a general scepticism about safety of medication in pregnancy. This may have some severe consequences if women are left without medical treatments in pregnancy.
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Affiliation(s)
- Irene Petersen
- Department of Primary Care and Population Health, UCL, London, UK
| | - Rachel L McCrea
- Department of Primary Care and Population Health, UCL, London, UK
| | - Angela Lupattelli
- Department of PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- Department of PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy, University of Oslo, Oslo, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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274
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Ersbøll AS, Hedegaard M, Damm P, Johansen M, Tabor A, Hegaard HK. Changes in the pattern of paracetamol use in the periconception period in a Danish cohort. Acta Obstet Gynecol Scand 2015; 94:898-903. [PMID: 25939806 DOI: 10.1111/aogs.12667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
Paracetamol is the most commonly used over-the-counter drug in pregnancy. It is generally considered to be safe, but prolonged antenatal exposure has been associated with offspring short- and long-term morbidity. Our aim was to describe the pattern of paracetamol use with a focus on frequent ingestion (more than once a week), 3 months before and in early pregnancy. In this cohort, 8650 pregnant women responded to a web-based clinical questionnaire that included questions about drug use. Paracetamol was the most used drug before and in early pregnancy (35.2% and 6.5% of respondents, respectively). The proportion of frequent users decreased from 3.9% before to 0.9% in early pregnancy. Frequent paracetamol use was associated with smoking, co-morbidities, body mass index ≥ 25 kg/m(2), unplanned pregnancy, no education and inability to understand Danish. A significant decrease in the proportion of women with any paracetamol use in early pregnancy was noted after access to large packs was restricted by legislation.
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Affiliation(s)
- Anne S Ersbøll
- Research Unit, Women's and Children's Health, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Hedegaard
- Research Unit, Women's and Children's Health, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Johansen
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Tabor
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Fetal Medicine and Ultrasound, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne K Hegaard
- Research Unit, Women's and Children's Health, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Child, Family, and Reproductive Health, Departments of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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275
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Trends and Determinants of Prescription Drug Use during Pregnancy and Postpartum in British Columbia, 2002-2011: A Population-Based Cohort Study. PLoS One 2015; 10:e0128312. [PMID: 26011706 PMCID: PMC4444135 DOI: 10.1371/journal.pone.0128312] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To describe trends, patterns, and determinants of prescription drug use during pregnancy and postpartum. Methods This is a retrospective, population-based study of all women who gave birth between January 2002 and 31 December 2011 in British Columbia, Canada. Study population consisted of 225,973 women who had 322,219 pregnancies. We examined administrative datasets containing person-specific information on filled prescriptions, hospitalizations, and medical services. Main outcome measures were filled prescriptions during pregnancy and postpartum. We used logistic regressions to examine associations between prescription drug use and maternal characteristics. Results Approximately two thirds of women filled a prescription during pregnancy, increasing from 60% in 2002 to 66% in 2011. The proportion of pregnant women using medicines in all three trimesters of pregnancy increased from 20% in 2002 to 27% in 2011. Use of four or more different types of prescription drug during at least one trimester increased from 8.4% in 2002 to 11.7% in 2011. Higher BMI, smoking during pregnancy, age under 25, carrying multiples, and being diagnosed with a chronic condition all significantly increased the odds of prescription drug use during pregnancy. Conclusions The observed increase in the number of prescriptions and number of different drugs being dispensed suggests a trend in prescribing practices with potentially important implications for mothers, their neonates, and caregivers. Monitoring of prescribing practices and further research into the safety of most commonly prescribed medications is crucial in better understanding risks and benefits to the fetus and the mother.
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276
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Dillon P, O'Brien KK, McDonnell R, Donnelly-Swift E, Galvin R, Roche A, Cronin K, Walsh DR, Schelten R, Smith S, Fahey T. Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study. BMC Pregnancy Childbirth 2015; 15:67. [PMID: 25884886 PMCID: PMC4389301 DOI: 10.1186/s12884-015-0489-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background To establish the prevalence and patterns of prescribing to pregnant women in an Irish primary care setting. Methods We reviewed electronic healthcare records routinely collected in primary care, of pregnant women attending nine Dublin-based General Practices affiliated to the Irish Primary Care Research Network (IPCRN) for antenatal care between January 2007 and October 2013 (n = 2,361 pregnancies). Results Excluding folic acid, 46.8% (n = 1,104) of pregnant women were prescribed at least one medication. Amoxicillin (11.1%, n = 263) and co-amoxiclav (8.0%, n = 190) were the most commonly prescribed medication followed by topical clotrimazole (4.9%, n = 117), salbutamol inhalers (4.1%, n = 96) and paracetamol (4.0%, n = 95). General Medical Services (GMS) patients were more likely to receive a prescription than private patients (OR 2.81; 95%CI (2.28, 3.47)). We applied the US FDA pregnancy-risk categories as a proxy measure of prescribing appropriateness, with FDA Category D and X medications considered inappropriate. FDA Category D drugs were prescribed in 5.9% (n = 140) of pregnancies. FDA Category X drugs were prescribed in 4.9% (n = 116) of pregnancies but after exclusion of oral contraceptives, progestogens, infertility treatments Category X medications were prescribed in 0.6% (n = 13) of pregnancies. After the initial antenatal consultation the prescribing prevalence of FDA Category D medications reduced to 4.7% (n = 110) and Category X to 3.1% (n = 72). Conclusions The overall prevalence of prescribing to pregnant women in our cohort is low compared to studies internationally, however similar levels of prescribing for FDA Category D and X were found. Following the initial antenatal consultation levels of prescribing of the FDA Category D and X medications reduced, however there is potential to further reduce their use in early pregnancy. The IPCRN database has provided valuable information on the current practice of antenatal prescribing within this pilot group of practices however it is limited by the absence of morbidity and pregnancy outcome data.
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Affiliation(s)
- Paul Dillon
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Kirsty K O'Brien
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Erica Donnelly-Swift
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Rose Galvin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Adam Roche
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Kate Cronin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - David R Walsh
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Rowan Schelten
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Susan Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, 2, Ireland.
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277
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Odalovic M, Tadic I, Lakic D, Nordeng H, Lupattelli A, Tasic L. Translation and factor analysis of structural models of Edinburgh Postnatal Depression Scale in Serbian pregnant and postpartum women - Web-based study. Women Birth 2015; 28:e31-5. [PMID: 25744940 DOI: 10.1016/j.wombi.2015.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/16/2014] [Accepted: 01/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) is well accepted for detecting symptoms of postnatal depression. The aim of this study was to examine psychometric properties and to evaluate structural models of the Serbian translation of EPDS in pregnant and postpartum women. METHODS The original English version of the EPDS was translated into Serbian, and checked by means of back-translation. Data were collected via an anonymous online questionnaire posted on a Serbian website devoted to pregnancy topics. The study sample included 201 women (76 pregnant, 125 postpartum). The internal consistency of the scale was measured by Cronbach's α coefficient. Principal component analysis was used to determine scale dimensions while confirmatory factor analysis was used to evaluate model fit. FINDINGS Cronbach α coefficient was 0.84 and 0.83 in pregnant and postpartum women, respectively, which indicated good internal consistency of the Serbian EPDS. Three dimensions of the scale were revealed in both groups of women. Goodness of fit indices described good and excellent model in pregnant and postpartum women, respectively. High level of depression symptoms (score ≥13) was recorded in 27.6% and 24.8% (p>0.05) of pregnant and postpartum women, respectively. Moderate level of depression symptoms (score 10-12) was recorded in 21.1% and 16.8% (p>0.05) of pregnant and postpartum women, respectively. CONCLUSION The Serbian translation of the EPDS showed good consistency and good model characteristics in pregnant and postpartum women. However, cut-off values, sensitivity and specificity of the scale should be determined in the further studies with more representative samples of women.
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Affiliation(s)
- Marina Odalovic
- Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade - Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia.
| | - Ivana Tadic
- Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade - Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Dragana Lakic
- Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade - Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Hedvig Nordeng
- School of Pharmacy, University of Oslo, PO Box 1068, Blindern, 0316 Oslo, Norway; Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Angela Lupattelli
- School of Pharmacy, University of Oslo, PO Box 1068, Blindern, 0316 Oslo, Norway
| | - Ljiljana Tasic
- Department of Social Pharmacy and Pharmaceutical Legislation, University of Belgrade - Faculty of Pharmacy, Vojvode Stepe 450, 11221 Belgrade, Serbia
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278
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Wacker E, Navarro A, Meister R, Padberg S, Weber-Schoendorfer C, Schaefer C. Does the average drug exposure in pregnant women affect pregnancy outcome? A comparison of two approaches to estimate the baseline risks of adverse pregnancy outcome. Pharmacoepidemiol Drug Saf 2015; 24:353-60. [PMID: 25644395 DOI: 10.1002/pds.3744] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/24/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022]
Abstract
PURPOSE The results of observational cohort studies on drug effects on pregnancy outcome may depend among others on suitable comparison cohorts. The aim of this investigation was to compare two distinct definitions of maternal exposure status for comparison cohorts. METHODS We performed an observational cohort study of prospectively ascertained pregnant women who spontaneously contacted the Teratology Information Service (TIS) Berlin for drug risk consultation. The only exclusion criteria were exposures to established teratogens and/or fetotoxicants. Pregnancy outcomes of 3250 women with this "average drug exposure" were compared with 546 non-exposed or insignificantly exposed pregnancies. RESULTS Neither the rate of major birth defects (3.0%; aOR 1.62; 95% CI 0.8-3.3) nor the risk of spontaneous abortion (16.0%; aHR 1.20; 95% CI 0.8-1.7) was significantly increased after average drug exposure, whereas the rate of electively terminated pregnancies was higher (11.1%; aHR 2.05; 95% CI 1.2-3.4). There were no differences in the risk of preterm birth (9.9%; aOR 1.38; 95% CI 0.9-2.0) and infants' birth weight (p = 0.60). CONCLUSIONS This study does not provide evidence for an increased risk of adverse pregnancy outcome after average drug exposure during pregnancy. Therefore, comparison cohorts with average drug exposure are appropriate for studies on potential teratogens or fetotoxicants based on observational data collected by TIS.
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Affiliation(s)
- Evelin Wacker
- Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie (Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy), Charité Universitätsmedizin Berlin, Berlin, Germany
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279
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Smedberg J, Lupattelli A, Mårdby AC, Øverland S, Nordeng H. The relationship between maternal depression and smoking cessation during pregnancy--a cross-sectional study of pregnant women from 15 European countries. Arch Womens Ment Health 2015; 18:73-84. [PMID: 25352316 DOI: 10.1007/s00737-014-0470-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 10/18/2014] [Indexed: 12/16/2022]
Abstract
Epidemiologic studies have reported an association between depression and continuing smoking during pregnancy. However, differences in study design and methodology challenge study comparability. The purpose of this study was to examine the relationship between maternal depression and continuing smoking among pregnant European women while adjusting for maternal characteristics. This multinational, web-based study evaluated pregnant women in 15 European countries recruited from October 2011 to February 2012. Data on depression status, smoking habits, maternal socio-demographic characteristics, and life-style factors were collected via an anonymous online questionnaire. Associations were estimated with logistic regression. Of 4,295 women included, 1,481 (34.5 %) reported smoking before pregnancy, and 391 (26.4 %) continued smoking during pregnancy whereof 127 (32.5 %) were depressed. The association between depression and continuing smoking during pregnancy were uniform across the European countries (OR 2.02, 95 % CI 1.50-2.71), with about twice the prevalence of continuing smoking among the depressed. There was a strong relationship between continuing smoking in pregnancy and low education level (OR 4.46, 95 % CI 2.72-7.32), which coincided with risky pregnancy behavior such as failure to attend pregnancy/birth preparation courses (OR 1.80, 95 % CI 1.19-2.72) and follow recommended use of folic acid (OR 1.81, 95 % CI 1.23-2.65). Women who perceived the risk for the fetus of continued smoking during pregnancy as higher were the least likely to continue smoking during pregnancy (OR 0.72, 95 % CI 0.68-0.77). This underlines the clustering of risk in some pregnant women, and the results should guide antenatal care of depressed women struggling to quit smoking during pregnancy.
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280
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Prescription drug use during pregnancy and risk of childhood cancer – Is there an association? Cancer Epidemiol 2015; 39:73-8. [DOI: 10.1016/j.canep.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022]
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281
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Dispensing of benzodiazepines and benzodiazepine-related drugs to pregnant women: a population-based cohort study. Eur J Clin Pharmacol 2014; 70:1367-74. [DOI: 10.1007/s00228-014-1744-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
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282
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Characteristics of women who continue smoking during pregnancy: a cross-sectional study of pregnant women and new mothers in 15 European countries. BMC Pregnancy Childbirth 2014; 14:213. [PMID: 24964728 PMCID: PMC4080751 DOI: 10.1186/1471-2393-14-213] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/18/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Some women continue smoking during pregnancy despite the extensive information available on the dangers smoking poses to their fetus. This study aimed to examine the prevalence and determinants of smoking before and during pregnancy and the extent of smoking during pregnancy from a European perspective in relation to maternal sociodemographic characteristics, health literacy, morbidity, and pregnancy-related factors. METHODS This multinational, web-based study evaluated pregnant women and new mothers in 15 European countries recruited from October 2011 to February 2012. Data were collected via an anonymous online questionnaire. RESULTS Of 8344 women included, 2944 (35.3%) reported smoking before pregnancy, and 771 (26.2%) continued smoking during pregnancy, 88 (11.4%) of whom smoked more than 10 cigarettes per day. There was a wide variation among the 15 European countries in smoking rates before and during pregnancy, ranging from 25.0% (Sweden) to 50.0% (Croatia) before and 4.2% (Iceland) to 18.9% (Croatia) during pregnancy. Women who lived in Eastern Europe, without a spouse/partner, with a low education level and unplanned pregnancy, who did not take folic acid, and consumed alcohol during pregnancy were the most likely to smoke before pregnancy. Women who lived in Eastern or Western Europe, without a spouse/partner, with a low education level and health literacy, being a housewife, having previous children and unplanned pregnancy, and who did not take folic acid were the most likely to continue smoking during pregnancy. Women who smoked more than 10 cigarettes per day during pregnancy were the most likely to be living in Eastern Europe and to have a low education level. CONCLUSION Women with fewer resources living in Western or Eastern Europe are more likely not only to smoke before pregnancy but also to continue smoking during pregnancy. These high-risk women are characterized as living alone, having high school or less as highest education level, having low health literacy, being a housewife, having previous children, having unplanned pregnancy, and no use of folic acid. Our findings indicated that focus on smoking cessation is important in antenatal care in Europe as many women smoke before pregnancy, and still continue to do so in pregnancy.
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283
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Hämeen-Anttila K, Kokki E, Lupattelli A, Nordeng H, Jyrkkä J, Vainio K, Enlund H. Factors associated with the need for information about medicines among pregnant women - a multinational internet-based survey. Res Social Adm Pharm 2014; 11:297-302. [PMID: 25096599 DOI: 10.1016/j.sapharm.2014.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women frequently experience health problems and use medicines during pregnancy, and thus need information about their medicines. Knowledge about factors associated with medicine information needs is important for pharmacists when tailoring medication counseling for these pregnant women. OBJECTIVES The aim was to investigate how socioeconomic factors, health literacy, health status, and use of medicines are associated with the need for drug information among pregnant women. METHODS A cross-sectional internet-based survey was posted using the Questback program (www.questback.com) on 1-4 websites commonly used by pregnant women in the participating countries within the Americas, Europe, and Australia. Multivariate logistic regression analysis was used. Logistic regression analysis was used for multivariate analysis when measuring the association of maternal socio-demographics and health-related characteristics with the need for medicines information. RESULTS A higher need for medicines information was associated with primiparity (OR 1.56, CI 1.40-1.75), age of 35+ years (OR 1.26, CI 1.03-1.54), university education (OR 1.33, CI 1.17-1.51), low health literacy (OR 1.96, CI 1.50-2.55), use of medication for chronic diseases (OR 2.67, CI 2.28-3.13), use of medication for acute illnesses (OR 1.88, CI 1.64-2.15), use of OTCs (2+ OTC medicines, OR 1.87, CI 1.60-2.20), use of herbal preparations (OR 1.57, CI 1.37-1.80), and region of residence in Eastern Europe (OR 2.36, CI 2.00-2.79) and Northern Europe (OR 1.26, CI 1.10-1.44). CONCLUSIONS The need for medicines information among pregnant women increases with the number of health problems and use of both prescription and OTC medicines as well as herbal preparations. Women with lower health literacy express a higher need for medicines information. These groups are primary targets for intensified counseling.
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Affiliation(s)
- Katri Hämeen-Anttila
- Assessment of Pharmacotherapies, Finnish Medicines Agency, P.O. Box 55, 00034 FIMEA, Kuopio, Finland.
| | - Esa Kokki
- Assessment of Pharmacotherapies, Finnish Medicines Agency, P.O. Box 55, 00034 FIMEA, Kuopio, Finland
| | | | - Hedvig Nordeng
- School of Pharmacy, University of Oslo, Oslo, Norway; Norwegian Institute of Public Health, Norway
| | - Johanna Jyrkkä
- Assessment of Pharmacotherapies, Finnish Medicines Agency, P.O. Box 55, 00034 FIMEA, Kuopio, Finland
| | - Kirsti Vainio
- University of Eastern Finland, School of Pharmacy, Kuopio, Finland
| | - Hannes Enlund
- Assessment of Pharmacotherapies, Finnish Medicines Agency, P.O. Box 55, 00034 FIMEA, Kuopio, Finland
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284
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Panchaud A, Weisskopf E, Winterfeld U, Baud D, Guidi M, Eap CB, Csajka C, Widmer N. Médicaments et grossesse : modifications pharmacocinétiques et place du suivi thérapeutique pharmacologique. Therapie 2014; 69:223-34. [DOI: 10.2515/therapie/2014026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/03/2014] [Indexed: 11/20/2022]
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285
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Hämeen-Anttila K, Nordeng H, Kokki E, Jyrkkä J, Lupattelli A, Vainio K, Enlund H. Multiple information sources and consequences of conflicting information about medicine use during pregnancy: a multinational Internet-based survey. J Med Internet Res 2014; 16:e60. [PMID: 24565696 PMCID: PMC3961698 DOI: 10.2196/jmir.2939] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 01/09/2023] Open
Abstract
Background A wide variety of information sources on medicines is available for pregnant women. When using multiple information sources, there is the risk that information will vary or even conflict. Objective The objective of this multinational study was to analyze the extent to which pregnant women use multiple information sources and the consequences of conflicting information, and to investigate which maternal sociodemographic, lifestyle, and medical factors were associated with these objectives. Methods An anonymous Internet-based questionnaire was made accessible during a period of 2 months, on 1 to 4 Internet websites used by pregnant women in 5 regions (Eastern Europe, Western Europe, Northern Europe, Americas, Australia). A total of 7092 responses were obtained (n=5090 pregnant women; n=2002 women with a child younger than 25 weeks). Descriptive statistics and logistic regression analysis were used. Results Of the respondents who stated that they needed information, 16.16% (655/4054) used one information source and 83.69% (3393/4054) used multiple information sources. Of respondents who used more than one information source, 22.62% (759/3355) stated that the information was conflicted. According to multivariate logistic regression analysis, factors significantly associated with experiencing conflict in medicine information included being a mother (OR 1.32, 95% CI 1.11-1.58), having university (OR 1.33, 95% CI 1.09-1.63) or other education (OR 1.49, 95% CI 1.09-2.03), residing in Eastern Europe (OR 1.52, 95% CI 1.22-1.89) or Australia (OR 2.28, 95% CI 1.42-3.67), use of 3 (OR 1.29, 95% CI 1.04-1.60) or >4 information sources (OR 1.82, 95% CI 1.49-2.23), and having ≥2 chronic diseases (OR 1.49, 95% CI 1.18-1.89). Because of conflicting information, 43.61% (331/759) decided not to use medication during pregnancy, 30.30% (230/759) sought a new information source, 32.67% (248/759) chose to rely on one source and ignore the conflicting one, 25.03% (190/759) became anxious, and 2.64% (20/759) did nothing. Factors significantly associated with not using medication as a consequence of conflicting information were being pregnant (OR 1.75, 95% CI 1.28-2.41) or experiencing 3-4 health disorders (OR 1.99, 95% CI 1.10-3.58). Women with no chronic diseases were more likely not to take medicines than women with ≥2 chronic diseases (OR 2.22, 95% CI 1.47-3.45). Factors significantly associated with becoming anxious were >4 information sources (OR 2.67, 95% CI 1.70-4.18) and residing in Eastern Europe (OR 0.57, 95% CI 0.36-0.90). Conclusions Almost all the pregnant women used multiple information sources when seeking information on taking medicines during pregnancy and one-fifth obtained conflicting information, leading to anxiety and the decision not to use the medication. Regional, educational, and chronic disease characteristics were associated with experiencing conflicting information and influenced the decision not to use medication or increased anxiety. Accurate and uniform teratology information should be made more available to the public.
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