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Viveiros Monteiro A. Arrhythmias in pregnancy: Is there anything else than just sinus tachycardia? Rev Port Cardiol 2024; 43:75-76. [PMID: 38122896 DOI: 10.1016/j.repc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
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Balon M, Tessier S, Damase-Michel C, Cottin J, Lambert A, Thompson MA, Benevent J, Lacroix I. Adverse drug reactions in pregnant women: Do they differ from those in non-pregnant women of childbearing age? Therapie 2023; 78:165-173. [PMID: 36517304 DOI: 10.1016/j.therap.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/14/2022] [Indexed: 11/30/2022]
Abstract
Pharmacoepidemiological research in pregnant women has focused on adverse drug reactions for the course of pregnancy or for the unborn child, but little is known on the risks for the mother. We reported the results of a study that compared adverse drug reactions in pregnant women with non-pregnant women of childbearing age, and investigated whether which types of adverse reactions were more often reported in pregnant women and which drugs were more often involved. This study was carried out in the French pharmacovigilance database (BNPV). We compared adverse drug reactions reported between 1 January 2010 and 31 December 2019 in pregnant women with those reported in of non-pregnant women of childbearing age. We cross-matched each pregnant woman with three non-pregnant women of childbearing age according to geographic area, age and year the adverse reaction was reported. Data analysis revealed that serious adverse reactions were more frequently reported in pregnant women, including anaphylactic reactions. Other adverse reactions including tachycardia, hypotension and hepatic injury were also more frequent in pregnant women than in non-pregnant women of the same age. This could be explained by physiological changes in pregnancy that lead to greater sensitivity to certain adverse reactions. Some drugs, such as phloroglucinol, metoclopramide, iron, atosiban and nifedipine, were more frequently involved in adverse reactions in pregnant women. These drugs are specifically used during pregnancy, which may explain why they are over-represented in adverse reactions. This is the first comparative descriptive study on drug adverse reactions in pregnant women. Specific epidemiological and pharmacokinetic studies are necessary to confirm these results and better understand the differences observed to improve the monitoring of pregnant women exposed to certain drugs.
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Affiliation(s)
- Maylis Balon
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Samuel Tessier
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Christine Damase-Michel
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Judith Cottin
- Centre régional de pharmacovigilance, hospices civils de Lyon, 69424 Lyon, France
| | - Aude Lambert
- Centre régional de pharmacovigilance, hôpital civil, 67091 Strasbourg, France
| | - Marie-Andrée Thompson
- Centre régional de pharmacovigilance, service de pharmacologie médicale et toxicologie, CHU de Montpellier, 34295 Montpellier, France
| | - Justine Benevent
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France
| | - Isabelle Lacroix
- Unité "Médicaments, grossesse et allaitement", service de pharmacologie médicale et clinique, centre régional de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament (CRPV), CHU de Toulouse, faculté de médecine, Inserm 1295 CERPOP, 31000 Toulouse, France.
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Abstract
Cardiovascular complications of pregnancy have risen substantially over the past decades, and now account for the majority of pregnancy-induced maternal deaths, as well as having substantial long-term consequences on maternal cardiovascular health. The causes and pathophysiology of these complications remain poorly understood, and therapeutic options are limited. Preclinical models represent a crucial tool for understanding human disease. We review here advances made in preclinical models of cardiovascular complications of pregnancy, including preeclampsia and peripartum cardiomyopathy, with a focus on pathological mechanisms elicited by the models and on relevance to human disease.
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Affiliation(s)
- Zolt Arany
- Department of Medicine and Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Denise Hilfiker-Kleiner
- Institute of Cardiovascular Complications in Pregnancy and in Oncologic Therapies, Philipps University Marburg, Germany (D.H.-K.)
| | - S Ananth Karumanchi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.A.K.)
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Omidi N, khorgami M, khatami F, Mahalleh M. Electrocardiographic indices and pregnancy: A focus on changes between first and third trimesters. Rev Port Cardiol 2022; 41:43-47. [DOI: 10.1016/j.repc.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 10/19/2022] Open
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Henry D, Gonzalez JM, Harris IS, Sparks T, Killion M, Thiet MP, Bianco K. Maternal arrhythmia and perinatal outcomes. J Perinatol 2016; 36:823-7. [PMID: 27309629 PMCID: PMC5045765 DOI: 10.1038/jp.2016.90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether arrhythmia in the setting of maternal cardiac disease (MCD) affects perinatal outcomes. STUDY DESIGN This is a retrospective cohort study of pregnant women with MCD who delivered during 2008 to 2013. Perinatal outcomes among women with an arrhythmia were compared with those without. RESULTS Among 143 women, 36 (25%) had an arrhythmia. Those with an arrhythmia were more likely to have a spontaneous vaginal delivery (64 vs 43%, P<0.05) and required fewer operative vaginal births (8 vs 27%, P=0.02). Pregnancies were more likely to be complicated by intrauterine growth restriction (IUGR) (17 vs 5%, P<0.05), although there were no differences in the rate of small for gestational age. The risk of IUGR remained increased after controlling for confounding (adjusted odds ratio 6.98, 95% confidence interval 1.59 to 30.79, P=0.01). Two cases of placental abruption were identified among mothers with arrhythmia while none were identified in the controls (P<0.05). CONCLUSION Patients with arrhythmias were more likely to have a spontaneous vaginal delivery. Our data suggest that these pregnancies were an increased risk for IUGR.
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Affiliation(s)
- Dana Henry
- Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, California
| | - Juan M Gonzalez
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Ian, S. Harris
- Department of Internal Medicine, University of California, San Francisco. San Francisco, California
| | - Teresa Sparks
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Molly Killion
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Mari-Paule Thiet
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco. San Francisco, California
| | - Katherine Bianco
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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Chen G, Sun G, Xu R, Chen X, Yang L, Bai Y, Yang S, Guo P, Zhang Y, Zhao C, Wang DW, Wang Y. Zero-fluoroscopy catheter ablation of severe drug-resistant arrhythmia guided by Ensite NavX system during pregnancy: Two case reports and literature review. Medicine (Baltimore) 2016; 95:e4487. [PMID: 27512864 PMCID: PMC4985319 DOI: 10.1097/md.0000000000004487] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiac arrhythmias can occur during pregnancy. Owing to radiation exposure and other uncertain risks for the mother and fetus, catheter ablation has rarely been performed and is often delayed until the postpartum period. We reported 2 pregnant women who were experiencing severe arrhythmias and were successfully ablated without fluoroscopic guidance. We also carried out a literature review of cases of pregnant women who underwent zero-fluoroscopy ablation. METHODS AND RESULTS One woman had drug-resistant and poorly tolerated frequent premature ventricular contraction (PVC) and ventricular tachycardia (VT). The other one had persistent and hardly terminated supraventricular tachycardia (SVT) via a right accessory pathway. The 2 patients were successfully underwent zero-fluoroscopy ablation guided by Ensite NavX system. The procedure time was 42 and 71 minutes, respectively. CONCLUSION Catheter ablation of SVT or PVC/VT in pregnant patients can be safely and effectively performed with a completely zero-fluoroscopy approach guided by the Ensite NavX system. In the case of a drug refractory, life-threatening arrhythmia during pregnancy, catheter ablation may be considered.
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